{"hospital_name":"Providence Health System - Southern California","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence Little Company of Mary Med Center Torrance"],"hospital_address":["4101 Torrance Blvd, Torrance, CA 90503"],"license_information":{"license_number":"930000089","state":"CA"},"type_2_npi":["1003084211"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Jason Kell"},"financial_aid_policy":["65% off of standard gross charges."],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Vivity City of LA Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Anthem Vivity Non City of LA Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"EPN/IFP Benefit Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Promise Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Tandem PPO/Blue High Performance PPO/EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CalOptima","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareMore","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"OA/OAP HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"Coventry All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Gold Coast Health PLan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Ambetter HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Ambetter PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Blue and Gold Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthNet","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Heritage Provider Network","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Inland Empire Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care Health Plan","plan_name":"Covered CA Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"LA Care Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Primary Network All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"OneCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Partnership Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"SCAN Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Select/Navigate HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"HC CATH FOGARTY 4FR 40CM","code_information":[{"code":"Px0000100878L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.51,"discounted_cash":79.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TERUMO 9FR 25CM 10/BX","code_information":[{"code":"Px0000100977L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.61,"discounted_cash":30.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KIT MICROSNARE 4MM SK400","code_information":[{"code":"Px0000102235L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2293.2,"discounted_cash":802.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTERCEED 3X4 4350 CDM","code_information":[{"code":"Px0000104075L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.8,"discounted_cash":724.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER ACCUSTICK 2-GW SET M001207020","code_information":[{"code":"Px0000104473L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.85,"discounted_cash":126.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BILIARY 8FR FIRM 27154","code_information":[{"code":"Px0000105941L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.63,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT CATH MAHURKAR CRV 11.5","code_information":[{"code":"Px0000106041L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.87,"discounted_cash":185.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE STR .035 GS3501","code_information":[{"code":"Px0000111329L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.01,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE BILI JAG STR .035X450 M00556581","code_information":[{"code":"Px0000112331L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 18FR 025018","code_information":[{"code":"Px0000114857L","type":"CDM"}],"standard_charges":[{"gross_charge":1001.63,"discounted_cash":350.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .018X180CM GR1806","code_information":[{"code":"Px0000115448L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":94.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE COIL PUSHER-16 M0014012160","code_information":[{"code":"Px0000115789L","type":"CDM"}],"standard_charges":[{"gross_charge":671.95,"discounted_cash":235.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .035 145CM G00691","code_information":[{"code":"Px0000115848L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.34,"discounted_cash":22.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET ACCESS INTRAHEPTIC TRANS-J G06541","code_information":[{"code":"Px0000116130L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2278.45,"discounted_cash":797.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE DOC .014/.018-145CM 22260","code_information":[{"code":"Px0000116505L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KIT SNARE GN 6FR 25MM GN2500","code_information":[{"code":"Px0000117030L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.75,"discounted_cash":389.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 8FR 25CM RSS806","code_information":[{"code":"Px0000117228L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.46,"discounted_cash":24.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE ANG TAPER 5FR 100CM CG508","code_information":[{"code":"Px0000117230L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.63,"discounted_cash":68.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE ANG TAPER 5FR 65CM CG507","code_information":[{"code":"Px0000117231L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.5,"discounted_cash":98.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ACCUSTICK II INTRODUCER KIT M001207030","code_information":[{"code":"Px0000117521L","type":"CDM"}],"standard_charges":[{"gross_charge":360.85,"discounted_cash":126.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE CHOICE PT .014-182CM H74912160012","code_information":[{"code":"Px0000118220L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN XXL 14 X 4 X 75 M001145140","code_information":[{"code":"Px0000118901L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 7F 25CM RSS706","code_information":[{"code":"Px0000119320L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.61,"discounted_cash":30.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 038 145CM","code_information":[{"code":"Px0000119558L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.51,"discounted_cash":25.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 260CM 3MM G00517","code_information":[{"code":"Px0000119965L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.52,"discounted_cash":32.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE C2 5FR 65CM CG502","code_information":[{"code":"Px0000120237L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 40CM .038 NS KMP G06749","code_information":[{"code":"Px0000121243L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.31,"discounted_cash":24.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DAWSON-MUELLER 8.5FR 25CM G09705","code_information":[{"code":"Px0000122635L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.1,"discounted_cash":115.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG EXCH .035 260CM GR3509","code_information":[{"code":"Px0000123611L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.82,"discounted_cash":62.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE JB1 5FR 100CM CG514","code_information":[{"code":"Px0000124411L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KIT SNARE GN 4FR 5MM GN500","code_information":[{"code":"Px0000124904L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.75,"discounted_cash":389.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT SNARE GOOSENECK 15MM HOOP GN1500","code_information":[{"code":"Px0000124905L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.75,"discounted_cash":389.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR 100CM .038 SIM1 G04922","code_information":[{"code":"Px0000126303L","type":"CDM"}],"standard_charges":[{"gross_charge":58.78,"discounted_cash":20.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR 100CM .038 SIM2 G05976","code_information":[{"code":"Px0000126304L","type":"CDM"}],"standard_charges":[{"gross_charge":58.78,"discounted_cash":20.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDECATH 4FR 65CM ANGLE TAPER CG415","code_information":[{"code":"Px0000127226L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.5,"discounted_cash":98.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE STIFF ANG .038 180","code_information":[{"code":"Px0000127609L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.84,"discounted_cash":82.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE SS ANG EX .035 260 GS3509","code_information":[{"code":"Px0000127738L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.89,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE GLD STIFF ST EXC .035 260 GS3504","code_information":[{"code":"Px0000128038L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.74,"discounted_cash":88.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE WHOLEY .035 145CM WWIJ35145","code_information":[{"code":"Px0000128045L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE .035X150CM SS ANG GS3506","code_information":[{"code":"Px0000128054L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.01,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMOSTAT SURGCEL FIB 1X2IN 1961","code_information":[{"code":"Px0000128068L","type":"CDM"}],"standard_charges":[{"gross_charge":528.68,"discounted_cash":185.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE SUPER STIFF 75CM","code_information":[{"code":"Px0000128211L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC G-WIRE SUPER STIFF 145CM M001465171","code_information":[{"code":"Px0000128212L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.2,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MAC-LOC 10.2FR 25 CLDM HC G09706","code_information":[{"code":"Px0000128498L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.1,"discounted_cash":115.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MAC-LOC 12FR 25CM CLM RH G09503","code_information":[{"code":"Px0000128499L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.4,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRAINAGE 14.0P-6S CLM RH G09504","code_information":[{"code":"Px0000128500L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.4,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIL 8FR .038 20CM COONS","code_information":[{"code":"Px0000128507L","type":"CDM"}],"standard_charges":[{"gross_charge":60.1,"discounted_cash":21.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIL 14FR .038 20CM COONS G03932","code_information":[{"code":"Px0000128697L","type":"CDM"}],"standard_charges":[{"gross_charge":56.34,"discounted_cash":19.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .035 180CM GR3508","code_information":[{"code":"Px0000128901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.49,"discounted_cash":70.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 7F 35CM 401735M","code_information":[{"code":"Px0000132132L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.1,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 7F 11CM 401711M","code_information":[{"code":"Px0000132416L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.96,"discounted_cash":26.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 6F 55CM 401655M","code_information":[{"code":"Px0000132484L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":35.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 6FR 23CM 401623M","code_information":[{"code":"Px0000132485L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE GLIDE ANG .025 180CM GR2505","code_information":[{"code":"Px0000132628L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":94.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 6F 35CM 401635M","code_information":[{"code":"Px0000132747L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE AMPLATZ SS J 035 180CM M001465011","code_information":[{"code":"Px0000132749L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.01,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC ANG .035INX180CM GS3508","code_information":[{"code":"Px0000132914L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.45,"discounted_cash":86.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 5FR 23CM 401523M","code_information":[{"code":"Px0000133015L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 9F 35CM","code_information":[{"code":"Px0000133188L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 5F 11CM 401511M","code_information":[{"code":"Px0000133230L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.96,"discounted_cash":26.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 6FR 11CM 401611M","code_information":[{"code":"Px0000133231L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.96,"discounted_cash":26.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INFLATION DEVICE ENCORE 26 H74904527011","code_information":[{"code":"Px0000133371L","type":"CDM"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":53.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 8F 35CM 401835M","code_information":[{"code":"Px0000134962L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.1,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE SUPRACORE35 300CM 100270302","code_information":[{"code":"Px0000135685L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE COPE 018 60CM NITINL G08427","code_information":[{"code":"Px0000135895L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.92,"discounted_cash":52.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAABE 7F 55CM G11633","code_information":[{"code":"Px0000137229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FLUSH 5F PIGTAIL G11272","code_information":[{"code":"Px0000137650L","type":"CDM"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 135/40 4105901","code_information":[{"code":"Px0000137833L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":133.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KUMPE BT 5F 65CM G09469","code_information":[{"code":"Px0000138161L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.83,"discounted_cash":27.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 8FR 11CM 401811M","code_information":[{"code":"Px0000138229L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.96,"discounted_cash":26.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRN MP FLXMA REG 8FR 25CM M001271340","code_information":[{"code":"Px0000138504L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.9,"discounted_cash":126.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIL CRE ESOPH PYLORIC 18-20MM M00558500","code_information":[{"code":"Px0000138551L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.68,"discounted_cash":369.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAABE 6FR .038 55CM RB G11638","code_information":[{"code":"Px0000139082L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 RIM G10082","code_information":[{"code":"Px0000139688L","type":"CDM"}],"standard_charges":[{"gross_charge":79.84,"discounted_cash":27.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 8FR 23CM 401823M","code_information":[{"code":"Px0000139690L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FOGARTY 5.5FR 12TLW805F35","code_information":[{"code":"Px0000139737L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 7FR 23CM 401723M","code_information":[{"code":"Px0000140220L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXOR RAABE RB 6F 70CM G11636","code_information":[{"code":"Px0000140328L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 6F 25CM RSS606","code_information":[{"code":"Px0000140706L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.46,"discounted_cash":24.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN 7FR 10CM RSS704","code_information":[{"code":"Px0000140978L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.81,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE SIM2 5FR 100CM CG511","code_information":[{"code":"Px0000141986L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BIL 10.2FR 40CM CLB RH G09498","code_information":[{"code":"Px0000142230L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.28,"discounted_cash":126.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BIL MACLC 8.5FR 40 CLB RH G09497","code_information":[{"code":"Px0000142231L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.28,"discounted_cash":126.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BIL 12FR 40CM CLB RH G09499","code_information":[{"code":"Px0000142232L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.28,"discounted_cash":126.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC TRANSEND EX-P .014 M001468080","code_information":[{"code":"Px0000143619L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.96,"discounted_cash":686.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUBE TRANSGASTRIC JEJUN 22FR 025022","code_information":[{"code":"Px0000143925L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.63,"discounted_cash":350.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 6F 10CM RSS602","code_information":[{"code":"Px0000144473L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.43,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN 8FR 10CM RSS802","code_information":[{"code":"Px0000144475L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.93,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN 5FR 25CM RSS506","code_information":[{"code":"Px0000144755L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.61,"discounted_cash":30.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 5F 10 CM RSS502","code_information":[{"code":"Px0000145003L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.93,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER ACCUSTICK INTRO SET M001207100","code_information":[{"code":"Px0000145243L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.25,"discounted_cash":133.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PARTICLES CONTOUR 250-355 M0017600351","code_information":[{"code":"Px0000145359L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.09,"discounted_cash":170.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH NEPH FLEX REG 10 X 25 M001271800","code_information":[{"code":"Px0000145418L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.5,"discounted_cash":130.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PROWLER 14","code_information":[{"code":"Px0000146317L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3619.46,"discounted_cash":1266.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SWANS GANZ 7FR 110CM 131F7P","code_information":[{"code":"Px0000147338L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE TRANSEND .014 EX SOFT TIP M001468060","code_information":[{"code":"Px0000149421L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.96,"discounted_cash":686.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE AMPLATZ SS .035 145CM M001465231","code_information":[{"code":"Px0000150936L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 9FR 23CM 401923M","code_information":[{"code":"Px0000151338L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER CK FLW XL 22FRX25CM G12831","code_information":[{"code":"Px0000151410L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1759.1,"discounted_cash":615.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOS OMNI 0 H787107204085","code_information":[{"code":"Px0000151436L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.8,"discounted_cash":28.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 90CM .035 RUC G26973","code_information":[{"code":"Px0000154466L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.75,"discounted_cash":59.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE TRANSEND EX .014 182 M001468050","code_information":[{"code":"Px0000154695L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.96,"discounted_cash":686.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 65CM C2 G11994","code_information":[{"code":"Px0000154886L","type":"CDM"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TRANSEND EX FLOPPY M001468070","code_information":[{"code":"Px0000155279L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.96,"discounted_cash":686.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILIARY 8FR 35CM M001271560","code_information":[{"code":"Px0000155285L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.9,"discounted_cash":126.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE WHISPER .014 190 CM 1005357H","code_information":[{"code":"Px0000155392L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE WHISPER .014-300 1005359H","code_information":[{"code":"Px0000155415L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH OMNI FLUSH 5FR 65CM H787107322035","code_information":[{"code":"Px0000155867L","type":"CDM"}],"standard_charges":[{"gross_charge":76.14,"discounted_cash":26.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH OMNI FLUSH 4FR 65CM","code_information":[{"code":"Px0000156017L","type":"CDM"}],"standard_charges":[{"gross_charge":80.8,"discounted_cash":28.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC PRWLR14 MRKR2 ANG90 606151MX","code_information":[{"code":"Px0000156033L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3718.18,"discounted_cash":1301.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET EMBL GLUE TRUFILL N-BCA 631500","code_information":[{"code":"Px0000156041L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":14233.4,"discounted_cash":4981.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 145CM COO G02356","code_information":[{"code":"Px0000156078L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.01,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE MAILMAN 182CM H74912136012","code_information":[{"code":"Px0000156151L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT WALLGRAFT 7F 10X68 75CM","code_information":[{"code":"Px0000156301L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4213.77,"discounted_cash":1474.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE MAILMAN 300 .014 H74912120012","code_information":[{"code":"Px0000156356L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH INFU CRAG-MCN 5FR 135/30 4105801","code_information":[{"code":"Px0000157258L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":133.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RCFW 18F 30CM CHECK-FLO G11672","code_information":[{"code":"Px0000157263L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.9,"discounted_cash":170.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 6F 25CM W/MKR RSB603","code_information":[{"code":"Px0000157425L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.3,"discounted_cash":36.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TREROTOLA THROMBO 5FR 65C","code_information":[{"code":"Px0000158161L","type":"CDM"}],"standard_charges":[{"gross_charge":3312.0,"discounted_cash":1159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRIVE UNIT TREROTOLA PT03000R","code_information":[{"code":"Px0000158162L","type":"CDM"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":187.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 260CM 3M AES G03460","code_information":[{"code":"Px0000158999L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.87,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CHECK FLO RCFW 16F 30CM","code_information":[{"code":"Px0000159043L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":88.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRAIN SKATER 8FR 25CM","code_information":[{"code":"Px0000159248L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRAIN SKATER 10FR 25CM","code_information":[{"code":"Px0000159249L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRAIN SKATER 12FR 25CM","code_information":[{"code":"Px0000159250L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRAIN SKATER 14FR 25CM","code_information":[{"code":"Px0000159251L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC EXCLSOR SL10 STR 2TIP M0031681890","code_information":[{"code":"Px0000159428L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.52,"discounted_cash":1264.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE AMPL SS ST EXC .035 260 M001465261","code_information":[{"code":"Px0000159521L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.7,"discounted_cash":60.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AMPLATZ SS 180CM .038 ST M001465191","code_information":[{"code":"Px0000159522L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.01,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TORNADO .035 5-3MM G10415","code_information":[{"code":"Px0000160157L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 5F 35CM 401535M","code_information":[{"code":"Px0000160166L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.1,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE TRANSEND .010 205 M003468020","code_information":[{"code":"Px0000160205L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.96,"discounted_cash":686.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PARTICLES CONTOUR 150-250 M0017600251","code_information":[{"code":"Px0000160313L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.09,"discounted_cash":170.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TORNADO .035 4-3MM","code_information":[{"code":"Px0000160736L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 6X40MMX75CM CQ7564","code_information":[{"code":"Px0000161059L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 10X40MMX75CM CQ75104","code_information":[{"code":"Px0000161060L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQUEST 8MM 4CM 75CM CQ7584","code_information":[{"code":"Px0000161061L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SIM 3 5/BX","code_information":[{"code":"Px0000202420L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE 5FR 100CM SIM1 CG510","code_information":[{"code":"Px0000202421L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SRO 406844","code_information":[{"code":"Px0000203284L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.5,"discounted_cash":238.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL TRANSSEPTAL BRK 18G 71CM 407200","code_information":[{"code":"Px0000203292L","type":"CDM"}],"standard_charges":[{"gross_charge":755.5,"discounted_cash":264.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL TRANSSEPTAL BRK-1 71 CM 407201","code_information":[{"code":"Px0000203293L","type":"CDM"}],"standard_charges":[{"gross_charge":755.5,"discounted_cash":264.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BMW 190CM","code_information":[{"code":"Px0000203762L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE IRON MAN 190CM 1001309","code_information":[{"code":"Px0000203763L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TORNADO .018 3-2MM G08261","code_information":[{"code":"Px0000204404L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TORNADO .018 4-2MM G08357","code_information":[{"code":"Px0000204405L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH KSAW-7.0-38-90-RBSHTLHC G12835","code_information":[{"code":"Px0000204940L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.98,"discounted_cash":175.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH INFU CRAG-MCN 4FR 135/10 4104101","code_information":[{"code":"Px0000204944L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":133.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOS 1 4F/80CM/.035 5/BX","code_information":[{"code":"Px0000204972L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO SO1 5FX80CM .038 H787107120055","code_information":[{"code":"Px0000204973L","type":"CDM"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOS 2 4F/80CM/.0 H787107114025","code_information":[{"code":"Px0000204974L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BERENSTEIN 4/100/035 H787107235015","code_information":[{"code":"Px0000205072L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SAFE 7FR 13CM HLS1007M","code_information":[{"code":"Px0000205073L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.55,"discounted_cash":54.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE V-18 .018/8/200 M001468520","code_information":[{"code":"Px0000205134L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.6,"discounted_cash":139.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE V-18 .018/8/300 M001468540","code_information":[{"code":"Px0000205135L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.65,"discounted_cash":146.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TERUMO 4FR 10CM 10/BX RSS404","code_information":[{"code":"Px0000205164L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.91,"discounted_cash":14.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TERUMO 5FR 10CM 10/BX RSS504","code_information":[{"code":"Px0000205165L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.92,"discounted_cash":15.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TERUMO 8FR 10CM 10/BX","code_information":[{"code":"Px0000205167L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.91,"discounted_cash":14.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TERUMO 9FR 10CM 10/BX","code_information":[{"code":"Px0000205168L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.81,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE TRANSEND .018 165CM","code_information":[{"code":"Px0000205774L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.56,"discounted_cash":275.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 6FR 45CM CL07645","code_information":[{"code":"Px0000205895L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 7FR 45CM CL07745","code_information":[{"code":"Px0000205903L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE V-18 .018/12/300 M001468600","code_information":[{"code":"Px0000205906L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.65,"discounted_cash":146.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD SCREW-IN 507645","code_information":[{"code":"Px0000206241L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD SCREW-IN 507652","code_information":[{"code":"Px0000206264L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE SPARTACORE 5/190 1005202","code_information":[{"code":"Px0000206332L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 700-900 2ML S820GH","code_information":[{"code":"Px0000206383L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.85,"discounted_cash":335.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 900-1200 2ML S1020GH","code_information":[{"code":"Px0000206384L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1202.85,"discounted_cash":421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE SUPRA CORE 35/190CM 100270301","code_information":[{"code":"Px0000206549L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD SCREW-IN 507658","code_information":[{"code":"Px0000207098L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUBE TRANSGASTRIC JEJUANL 16F 025016","code_information":[{"code":"Px0000207319L","type":"CDM"}],"standard_charges":[{"gross_charge":1001.63,"discounted_cash":350.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TORNADO .018 5-2MM G08356","code_information":[{"code":"Px0000207333L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.95,"discounted_cash":157.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL MWCE-18S-7/3-TORNADO 1/PK G09218","code_information":[{"code":"Px0000207334L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDECATH JB1 4/100","code_information":[{"code":"Px0000207433L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD FINELINE II EASY 4471","code_information":[{"code":"Px0000210288L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION ST 6/45 RSR01","code_information":[{"code":"Px0000210630L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ANGIO .035 3MM H965970002021","code_information":[{"code":"Px0000211230L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.59,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SRO 8.5F 406853","code_information":[{"code":"Px0000211266L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.5,"discounted_cash":238.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE ST .035 260CM G00655","code_information":[{"code":"Px0000216747L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":20.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TORNADO 35-10/5 G10413","code_information":[{"code":"Px0000216913L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 80CM .038 MIK G09312","code_information":[{"code":"Px0000217173L","type":"CDM"}],"standard_charges":[{"gross_charge":99.55,"discounted_cash":34.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KIT ENSNARE 6FR 12-20MM","code_information":[{"code":"Px0000217285L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVUS EAGLE EYE GOLD 3.5F 85900","code_information":[{"code":"Px0000217639L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3237.0,"discounted_cash":1132.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMODIALYSIS DURFLOW 24 BX 5 EA 10301201","code_information":[{"code":"Px0000218141L","type":"CDM"},{"code":"C1881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.0,"discounted_cash":381.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMODIALYSIS DURAFLOW 28 10301202","code_information":[{"code":"Px0000218142L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.0,"discounted_cash":381.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE PILOT 1010482H","code_information":[{"code":"Px0000218254L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR 100CM .38 JB2 B G09654","code_information":[{"code":"Px0000218266L","type":"CDM"}],"standard_charges":[{"gross_charge":99.55,"discounted_cash":34.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH 10FR .038 30CM RB","code_information":[{"code":"Px0000218348L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.02,"discounted_cash":57.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RCFW 12F 30CM CHECK-FLO G08956","code_information":[{"code":"Px0000218349L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.65,"discounted_cash":105.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 10FR 23CM 401023M","code_information":[{"code":"Px0000218866L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MIXER CEM KYPHON W/KYPHX HV-R C01B","code_information":[{"code":"Px0000219208L","type":"CDM"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":271.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 7X40MMX75CM CQ7574","code_information":[{"code":"Px0000219264L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE PROWATER .014 180 AGH146000","code_information":[{"code":"Px0000219404L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE GRANDSLAM .014 180 12781-01 AG141002","code_information":[{"code":"Px0000219405L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":148.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH INTRODUCER 12.0-38 G07369","code_information":[{"code":"Px0000219408L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.94,"discounted_cash":74.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROINTRODUCER 5.0FX10CM 0669050","code_information":[{"code":"Px0000219727L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.89,"discounted_cash":66.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET RETRIEVAL GUNTHER TULIP G13287","code_information":[{"code":"Px0000220009L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1375.95,"discounted_cash":481.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 11FR 038 70CM G11240","code_information":[{"code":"Px0000220010L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.52,"discounted_cash":141.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXR 10FR .038 40CM RB G32233","code_information":[{"code":"Px0000220011L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.52,"discounted_cash":99.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CEMENT BONE KYPH HV-R C01A","code_information":[{"code":"Px0000220216L","type":"CDM"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SHUTTL 6FR .038 90CM HC G13264","code_information":[{"code":"Px0000220305L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE RDC 7FR 55CM 77821255","code_information":[{"code":"Px0000220975L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":106.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT PERCLOSE PROGLIDE 6FR 1267303","code_information":[{"code":"Px0000221040L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT 1ST FRACTURE EXPRESS 10/2 KPE1001","code_information":[{"code":"Px0000221561L","type":"CDM"}],"standard_charges":[{"gross_charge":9680.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER EXPRESS OSTEO KYPH T24A","code_information":[{"code":"Px0000221563L","type":"CDM"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":600.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEVICE BONE BIOPSY EXPRESS F07A","code_information":[{"code":"Px0000221565L","type":"CDM"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT MINIVISION RX 2.0 X 12MM 100782112","code_information":[{"code":"Px0000221807L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 16FR 038 30CM G09691","code_information":[{"code":"Px0000221922L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.9,"discounted_cash":170.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 C2 G08447","code_information":[{"code":"Px0000221923L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.55,"discounted_cash":34.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE BALANCE M/W UNIV 190CM 1009660","code_information":[{"code":"Px0000222154L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE SYNCRO 14 200CM M00313010","code_information":[{"code":"Px0000222155L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2454.1,"discounted_cash":858.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KIT RENE HIFLO W/.018 135 M001183020","code_information":[{"code":"Px0000222156L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2142.67,"discounted_cash":749.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RENEGADE HI/FLO 150CM","code_information":[{"code":"Px0000222295L","type":"CDM"}],"standard_charges":[{"gross_charge":1426.99,"discounted_cash":499.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X38X80 85402","code_information":[{"code":"Px0000222538L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X59X80 85403","code_information":[{"code":"Px0000222539L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X38X80 85404","code_information":[{"code":"Px0000222540L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X59X80 85405","code_information":[{"code":"Px0000222541L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 5X38X120 85410","code_information":[{"code":"Px0000222542L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE MIRCLBRO 3 .014/180 AG14M050","code_information":[{"code":"Px0000223016L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE MIRCLBRO 6 .014/180 AG14M060","code_information":[{"code":"Px0000223018L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 500-700 2ML S620GH","code_information":[{"code":"Px0000223929L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.8,"discounted_cash":249.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 300-500 2ML S420GH","code_information":[{"code":"Px0000223930L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.8,"discounted_cash":249.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYR EMBOSPHERE 100-300 2ML S220GH","code_information":[{"code":"Px0000223931L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.8,"discounted_cash":249.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SKATER BILIARY DRAIN 8F","code_information":[{"code":"Px0000227386L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 5X38X80 85400","code_information":[{"code":"Px0000227404L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 9X38X80 85408","code_information":[{"code":"Px0000227406L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 9X59X80C 85409","code_information":[{"code":"Px0000227407L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE ASAHI MIRACLBRO 300 3 AG14M350","code_information":[{"code":"Px0000227456L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE ASAHI MIRACLBRO 300 6 AG14M360","code_information":[{"code":"Px0000227457L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE ASAHI CONFIANZA 300 AG143390","code_information":[{"code":"Px0000227458L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE 3MM J 035 X 150","code_information":[{"code":"Px0000228069L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.3,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION MP CC 7F RSR06","code_information":[{"code":"Px0000228070L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION HS CC 6F RSR02","code_information":[{"code":"Px0000228071L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION MP CC 6F RSR03","code_information":[{"code":"Px0000228072L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISION RX 3.0 X 28MM 100784828","code_information":[{"code":"Px0000228423L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISION RX 4.0 X 18MM 100785018","code_information":[{"code":"Px0000228428L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE BMW .014-300 1001782-HC 1001782HC","code_information":[{"code":"Px0000228538L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RENEGADE HI/FLO 135CM M001182880","code_information":[{"code":"Px0000228614L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1426.99,"discounted_cash":499.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRC 4.0X20MMX135CM 100818920","code_information":[{"code":"Px0000228790L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRC 6.0X20MMX135CM 100819720","code_information":[{"code":"Px0000228792L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRAC 7 X 20MM 100820120","code_information":[{"code":"Px0000228793L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN VIATRAC 5 X 30MM 100819330","code_information":[{"code":"Px0000228795L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC ECHELON 10 155 ST 1055091150","code_information":[{"code":"Px0000228853L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2720.85,"discounted_cash":952.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO ECHELON10 155 90DEG 1905091150","code_information":[{"code":"Px0000228854L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2885.75,"discounted_cash":1010.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO ECHELON 14 155 ST 1055092150","code_information":[{"code":"Px0000228855L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2720.85,"discounted_cash":952.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO ECHELON14 155 90DEG 1905092150","code_information":[{"code":"Px0000228856L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2885.75,"discounted_cash":1010.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE MIRAGE 008 200CM 1030608","code_information":[{"code":"Px0000228857L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1692.9,"discounted_cash":592.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAABE 8FR .038 55CM RB G12242","code_information":[{"code":"Px0000228940L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL2 6FR 018/038 45CM G29983","code_information":[{"code":"Px0000229406L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE COR WHISPER J 190CM 1005357HJ","code_information":[{"code":"Px0000229569L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EP 7FR DUO-DECA MC LW 401908","code_information":[{"code":"Px0000229793L","type":"CDM"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":4376.41,"discounted_cash":1531.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE HT IRONMAN EXCHANGE 1001311","code_information":[{"code":"Px0000229897L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE WHOLEY .035 X 175CM","code_information":[{"code":"Px0000229927L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":200.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR .038 100CM VERT","code_information":[{"code":"Px0000230034L","type":"CDM"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CEREB 5FR 125CM .038 VERT G12170","code_information":[{"code":"Px0000230661L","type":"CDM"}],"standard_charges":[{"gross_charge":99.55,"discounted_cash":34.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EP 6FR DECA MS LIVEWIRE 401575","code_information":[{"code":"Px0000231145L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.49,"discounted_cash":597.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MEDIA KUMPE 5FR 65CM","code_information":[{"code":"Px0000231655L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.98,"discounted_cash":14.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MEDIA RIM 5FR 65CM H787107333015","code_information":[{"code":"Px0000231657L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.2,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL1 6FR 018/038 45CM G29982","code_information":[{"code":"Px0000231928L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .035 200CM G01095","code_information":[{"code":"Px0000233038L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.3,"discounted_cash":22.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ELECTRODE CATH PACING 5FR 401770","code_information":[{"code":"Px0000233367L","type":"CDM"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE RUNWAY 6FR LCB H74938969250","code_information":[{"code":"Px0000235348L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE 0.014 BMW 182CM I 1001780HC","code_information":[{"code":"Px0000235674L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE SPARTA .014 300CM 1005203","code_information":[{"code":"Px0000235867L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE V-18 .018 150CM M001468500","code_information":[{"code":"Px0000235870L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.5,"discounted_cash":132.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RENAL MP DEST 7F PINN P RSR04","code_information":[{"code":"Px0000236198L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE RUNWAY 6FR VL3.5 H74938969720","code_information":[{"code":"Px0000236208L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRAINAGE 7.0P-5S CLDM-HC G11020","code_information":[{"code":"Px0000236218L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.11,"discounted_cash":115.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE DESTIN 6FRX90C RSC01","code_information":[{"code":"Px0000236429L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SWAN GANZ S-CRV 7FR 151F7","code_information":[{"code":"Px0000236558L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 5X40MMX75CM CQ7554","code_information":[{"code":"Px0000236845L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE RUNWAY 6FR VL-3 A","code_information":[{"code":"Px0000236909L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN DESTIN 7FX90C RSC02","code_information":[{"code":"Px0000236952L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER BRST 11G MAMMOMARK MAM3001","code_information":[{"code":"Px0000237106L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.1,"discounted_cash":72.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ASAHI 4.5 .014 300CM","code_information":[{"code":"Px0000237449L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.5,"discounted_cash":109.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE AMPLATZER J .035/260 9GW002","code_information":[{"code":"Px0000238296L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":99.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PEG SAFETY PULL 20FR ZYLOCAINE M00566461","code_information":[{"code":"Px0000238337L","type":"CDM"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 7X40X75 1275904","code_information":[{"code":"Px0000238357L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"discounted_cash":100.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 9X40X75","code_information":[{"code":"Px0000238363L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"discounted_cash":100.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 5X40X135","code_information":[{"code":"Px0000238368L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"discounted_cash":118.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .014 X 135CM 518032","code_information":[{"code":"Px0000238451L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE SYNCHRO .010/200 M00316310","code_information":[{"code":"Px0000238453L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2751.7,"discounted_cash":963.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PROGREAT 2.8FR 130","code_information":[{"code":"Px0000238473L","type":"CDM"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":302.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE XPEDION .010 200CM 1030605200","code_information":[{"code":"Px0000238824L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE ROTA FLOPPY 325 CM H802228240022","code_information":[{"code":"Px0000238874L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":243.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RO/MARKER 6F RSB601","code_information":[{"code":"Px0000239021L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.69,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RO/MARKER 7F RSB701","code_information":[{"code":"Px0000239022L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.69,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE GT .018 180CM STRT","code_information":[{"code":"Px0000239024L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SIZING PIGTAIL 5FR 70CM H787137098015","code_information":[{"code":"Px0000239665L","type":"CDM"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE AMPLZ SS .038/260 M001465201","code_information":[{"code":"Px0000240826L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.5,"discounted_cash":48.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE .038 GLIDE CURVED GR3808","code_information":[{"code":"Px0000240827L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.49,"discounted_cash":70.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 4FR 10CM RSS402","code_information":[{"code":"Px0000240869L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.93,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE STRT TAPER 5FR 65C CG505","code_information":[{"code":"Px0000240892L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH 6FR PIG-145 08641-41 H74908641412","code_information":[{"code":"Px0000240899L","type":"CDM"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDECATH 4FR 100CM ANGLE TAPER CG416","code_information":[{"code":"Px0000240903L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.63,"discounted_cash":68.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE RUNWAY 6FR AL1 H74938969190","code_information":[{"code":"Px0000240953L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STARTER BENTSON 035 150CM M001491451","code_information":[{"code":"Px0000240964L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.18,"discounted_cash":22.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .032 145CM G00688","code_information":[{"code":"Px0000241167L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROPUNCT 4FR NITNL/SST PED","code_information":[{"code":"Px0000241233L","type":"CDM"}],"standard_charges":[{"gross_charge":113.68,"discounted_cash":39.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SNARE GOOSENECK 10MM GN1000","code_information":[{"code":"Px0000241685L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.75,"discounted_cash":389.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE J LG .035X150","code_information":[{"code":"Px0000243457L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.29,"discounted_cash":13.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE ROSEN 260CM","code_information":[{"code":"Px0000244008L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.41,"discounted_cash":28.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDE WIRE 0.018IN 150CM GR1805","code_information":[{"code":"Px0000244009L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.75,"discounted_cash":94.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SUPER ARROWFLX 8FR 24CM CL07824","code_information":[{"code":"Px0000246867L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.34,"discounted_cash":82.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TRANSS SL1 8.5F 406849","code_information":[{"code":"Px0000247019L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.5,"discounted_cash":238.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IR FOGARTY THRU-LUMEN 6FR 40CM 12TLW405F35","code_information":[{"code":"Px0000247228L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXOR BLKN RB 6F 40CM G10383","code_information":[{"code":"Px0000247246L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.15,"discounted_cash":79.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MAC-LOC 8.5FR 25CM CLM RH G09501","code_information":[{"code":"Px0000247284L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.4,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MAC-LOC 10.2FR 25 CLB HC G09502","code_information":[{"code":"Px0000247356L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.4,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IR TEMPO CATH BERENSTEIN 4FR","code_information":[{"code":"Px0000247410L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.55,"discounted_cash":28.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOS OMNI 2 5FR 80CM H787107204055","code_information":[{"code":"Px0000247496L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.18,"discounted_cash":35.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IR RNGDE MICROCATH 150CM/20 18253","code_information":[{"code":"Px0000247515L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.96,"discounted_cash":514.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IR PALMAZ XL STENT 40MM P4010","code_information":[{"code":"Px0000247529L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5110.35,"discounted_cash":1788.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 7F 25CM W/MKR RSB703","code_information":[{"code":"Px0000247538L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.3,"discounted_cash":45.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 11F RSS104","code_information":[{"code":"Px0000247877L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.81,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH INFUSION PROWLER PLUS MAX 6062510MX","code_information":[{"code":"Px0000247994L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3718.18,"discounted_cash":1301.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT PROTEGE 10X60 6FR 80CM SERB65106080","code_information":[{"code":"Px0000248593L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ATLAS 12X4 75CM AT75124","code_information":[{"code":"Px0000248828L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SHTL 6FR .038 90CM HC F G31138","code_information":[{"code":"Px0000248911L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.2,"discounted_cash":196.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNILINK 7X28 80CM 100818028","code_information":[{"code":"Px0000248973L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DAWSON-MUELLER 12FR 25CM G10435","code_information":[{"code":"Px0000249209L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.11,"discounted_cash":115.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT GRAFT BALLOON CATH REL46","code_information":[{"code":"Px0000249250L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1935.5,"discounted_cash":677.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 5X16X80 85440","code_information":[{"code":"Px0000249288L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 6X16X80 85442","code_information":[{"code":"Px0000249289L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EP XTRA 3 CRV MD 227F3","code_information":[{"code":"Px0000249338L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":5347.5,"discounted_cash":1871.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .038X150CM GR3806","code_information":[{"code":"Px0000249951L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.45,"discounted_cash":51.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SKATER DRAIN 16FR 25CM 756516025","code_information":[{"code":"Px0000250301L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISION RX 2.75 X 12MM 100784712","code_information":[{"code":"Px0000250549L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PROWLER 14 45 DEG","code_information":[{"code":"Px0000250561L","type":"CDM"}],"standard_charges":[{"gross_charge":3718.18,"discounted_cash":1301.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PROWLER PLUS 45 DEG 6062510FX","code_information":[{"code":"Px0000250562L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3718.18,"discounted_cash":1301.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE ENVOY MPD 90 CM 5FR 55625890","code_information":[{"code":"Px0000250566L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.6,"discounted_cash":658.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE ENVOY MPD 90CM 6FR 67025890","code_information":[{"code":"Px0000250567L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.87,"discounted_cash":534.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUAD JSN 5FR","code_information":[{"code":"Px0000250603L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.25,"discounted_cash":185.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE ROSEN 035 260CM 1.5MM G01253","code_information":[{"code":"Px0000251786L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.68,"discounted_cash":39.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 50CM 3MM G00524","code_information":[{"code":"Px0000251796L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.19,"discounted_cash":16.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .035 260CM G01063","code_information":[{"code":"Px0000251863L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.58,"discounted_cash":28.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OCCLUSION 11.5/6/80","code_information":[{"code":"Px0000251931L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.2,"discounted_cash":300.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE NITINOL US1817 IN FIRMIN N180802","code_information":[{"code":"Px0000252041L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .025 145CM","code_information":[{"code":"Px0000252049L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.27,"discounted_cash":22.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FLUSH 4FR 100CM .035 PIG","code_information":[{"code":"Px0000252405L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BALKN 7FR .038 40CM RB G10384","code_information":[{"code":"Px0000252551L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.15,"discounted_cash":79.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT TREROTOLA PTD PT-65509 PT65509","code_information":[{"code":"Px0000252560L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1970.0,"discounted_cash":689.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FLUSH 5FR 100CM .038 PIG","code_information":[{"code":"Px0000252695L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE STANDARD .035X260CM GR3504","code_information":[{"code":"Px0000252814L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.22,"discounted_cash":78.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DENNY 4.5FR .018 9CM","code_information":[{"code":"Px0000252845L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":97.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DAIG 5FR QUAD CRD-2 401860","code_information":[{"code":"Px0000252978L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.25,"discounted_cash":185.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH 08641-215 6FR PIG H749086412152","code_information":[{"code":"Px0000253039L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FOUNTAIN INF 4FR 135X20CM","code_information":[{"code":"Px0000253102L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SIZING CENT 5.0FR 100CM .035 PIG G11916","code_information":[{"code":"Px0000253287L","type":"CDM"}],"standard_charges":[{"gross_charge":537.14,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE RUNWAY 6FR FR4 A H74938969020","code_information":[{"code":"Px0000253336L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ATLAS 14X4 75CM AT75144","code_information":[{"code":"Px0000253418L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 120CM ANGLED CG417","code_information":[{"code":"Px0000253634L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT URO AMPLATZ 8.5FR 28CM G09711","code_information":[{"code":"Px0000253681L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.87,"discounted_cash":199.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE NITREX STIFF .035 180CM","code_information":[{"code":"Px0000253779L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE PROWATER .014 300CM AGH146300","code_information":[{"code":"Px0000253846L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 5X22X120 85451","code_information":[{"code":"Px0000254041L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X22X120 85455","code_information":[{"code":"Px0000254042L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 5X16X120 85450","code_information":[{"code":"Px0000254047L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X38X80 85406","code_information":[{"code":"Px0000254048L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X59X80 85407","code_information":[{"code":"Px0000254049L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 5X22X80 85441","code_information":[{"code":"Px0000254050L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE TRANSEND FLOPPY .014 300 M003468150","code_information":[{"code":"Px0000254349L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2328.48,"discounted_cash":814.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 6FR 14X40MMX80 SERB65144080","code_information":[{"code":"Px0000254384L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE RO II 10 6FR RSB602","code_information":[{"code":"Px0000254782L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.07,"discounted_cash":37.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE 6FR AL3.0 H749086411002","code_information":[{"code":"Px0000254856L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE .016/180 25TIP FATHM M001509100","code_information":[{"code":"Px0000255447L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.54,"discounted_cash":371.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER TRIMARK 13 TRIMARKTD13MR","code_information":[{"code":"Px0000255507L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":74.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC AMPL SUPSTI 035X75 M001465631","code_information":[{"code":"Px0000255599L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.2,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE ANG TERUMO 038 X 260","code_information":[{"code":"Px0000255624L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.22,"discounted_cash":78.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE STIFF STR TERUMO 035X180 GS3503","code_information":[{"code":"Px0000255625L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.14,"discounted_cash":66.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIOJET DVX 6FR 90CM 105420001","code_information":[{"code":"Px0000255893L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":3075.0,"discounted_cash":1076.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ATLAS 7FR 14X40MMX120CM AT120144","code_information":[{"code":"Px0000255897L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE LQST STR XSTIF 260X11 G31453","code_information":[{"code":"Px0000256378L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAABE 7FR .038 70CM RB G11635","code_information":[{"code":"Px0000257143L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE RUNWAY 6FR MP1 A H74938969380","code_information":[{"code":"Px0000257545L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC D-STAT FLOWABLE 4000","code_information":[{"code":"Px0000257859L","type":"CDM"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT ONYX 18 LIQUID EMBOLIC 1057100060","code_information":[{"code":"Px0000258073L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10287.75,"discounted_cash":3600.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT ONYX 34 LIQUID EMBOLIC 1057100080","code_information":[{"code":"Px0000258074L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10287.75,"discounted_cash":3600.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO MARATHON 170CM 1055055","code_information":[{"code":"Px0000258075L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1677.5,"discounted_cash":587.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEVICE TORQUE 22215","code_information":[{"code":"Px0000258525L","type":"CDM"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IABP 7.5FR 40CC 068400048001U","code_information":[{"code":"Px0000258612L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3230.4,"discounted_cash":1130.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLUDER AMPLATZER SEPTAL 10MM 9ASD010","code_information":[{"code":"Px0000258675L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":28303.8,"discounted_cash":9906.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE BNTSN .038 145CM","code_information":[{"code":"Px0000258763L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BIL 8.3FR 50CM 32 SIDEPRT","code_information":[{"code":"Px0000258764L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":39.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 65CM RIM","code_information":[{"code":"Px0000258774L","type":"CDM"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .035 X 135CM 518037","code_information":[{"code":"Px0000259236L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH LASER VITESSE RX 1.4 MM 114009","code_information":[{"code":"Px0000259239L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":10657.5,"discounted_cash":3730.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH LASER VITESSE RX 0.9 MM 110004","code_information":[{"code":"Px0000259240L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":10657.5,"discounted_cash":3730.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PROGRT 2.8FR W/MKR","code_information":[{"code":"Px0000259268L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.5,"discounted_cash":537.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE GT .018 DBL ANG","code_information":[{"code":"Px0000259269L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROT XACT STR 7X30MM 8209401","code_information":[{"code":"Px0000259352L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8757.6,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROT XACT STR 8X30MM 8209201","code_information":[{"code":"Px0000259353L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8757.6,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROT XACT TPR 8X30MM 8209101","code_information":[{"code":"Px0000259356L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8757.6,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROTID XACT 9-7X30 TPR 8208701","code_information":[{"code":"Px0000259357L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8757.6,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROT XACT TPR 8X40MM 8209001","code_information":[{"code":"Px0000259359L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8757.6,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROT XACT TPR 9X7X40MM 8208601","code_information":[{"code":"Px0000259360L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8757.6,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT STARCLOSE 6 F 1467701","code_information":[{"code":"Px0000259487L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.5,"discounted_cash":188.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BMW J 300CM 1001782J","code_information":[{"code":"Px0000259907L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":56.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 80CM VS1 G13432","code_information":[{"code":"Px0000260282L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MHRKR PRECRV TL 12FR 16CM 8888101002HP","code_information":[{"code":"Px0000260511L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.46,"discounted_cash":215.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SHUTL 6.5 FR 125 CM VTK SCBR6535125PNSVTKSHT G36362","code_information":[{"code":"Px0000260827L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.25,"discounted_cash":70.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FLUSH 5FR 70CM .035 CSC G31215","code_information":[{"code":"Px0000260851L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE MIRACLBRO12 .014/180 AG14M070","code_information":[{"code":"Px0000261136L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE CONFIANZA12 .014/180 AGH143091","code_information":[{"code":"Px0000261137L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GDW .035-.038 X 150 ANGLED XR GR3506","code_information":[{"code":"Px0000261742L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.45,"discounted_cash":51.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DAIG 5FR QUAD CRD-2 -REP 401860RH","code_information":[{"code":"Px0000262614L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.29,"discounted_cash":63.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 11F 10CM RSS103","code_information":[{"code":"Px0000263214L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.19,"discounted_cash":15.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT PERCLOSE CLOSER AT 6FR","code_information":[{"code":"Px0000263335L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE STRAIGHT TERUMO .035 150 GR3501","code_information":[{"code":"Px0000263466L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.45,"discounted_cash":51.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X150MM X 120CM PRB3507150120","code_information":[{"code":"Px0000263510L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2667.5,"discounted_cash":933.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING SV 7X2X135 3903170201","code_information":[{"code":"Px0000264005L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING SV 4X2X150 H74939031402010","code_information":[{"code":"Px0000264006L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN STRLG MR5.0X20MMX135 H74939031502010","code_information":[{"code":"Px0000264007L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING 3X20X135 H74939031302010","code_information":[{"code":"Px0000264010L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STRLG MR 3.0X60MMX135CM","code_information":[{"code":"Px0000264012L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING 5X10X135 H74939032501010","code_information":[{"code":"Px0000264014L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING 6X10X135 H74939032601010","code_information":[{"code":"Px0000264015L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH BALKN 8FR .038 40CM RB G10385","code_information":[{"code":"Px0000264089L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.15,"discounted_cash":79.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ISOTOPE SIR SPHERE Y90 SIRY001","code_information":[{"code":"Px0000264568L","type":"CDM"},{"code":"C2616","type":"HCPCS"}],"standard_charges":[{"gross_charge":78430.85,"discounted_cash":27450.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT 1ST FRACTURE EXPRESS 15/2 KPE1003","code_information":[{"code":"Px0000265390L","type":"CDM"}],"standard_charges":[{"gross_charge":9680.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X100MM X 120CM PRB3506100120","code_information":[{"code":"Px0000266002L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X120MM X 120CM PRB3506120120","code_information":[{"code":"Px0000266003L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X150MM X 120CM PRB3506150120","code_information":[{"code":"Px0000266004L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2667.5,"discounted_cash":933.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X100MM X 120CM PRB3508100120","code_information":[{"code":"Px0000266006L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIOSEAL VIP 6F 610130","code_information":[{"code":"Px0000292099L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PWRLINE CUFF DL 6FR 0700615","code_information":[{"code":"Px0000292188L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.6,"discounted_cash":429.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PORT INFUS X-PRT SL 8FR 61CM K","code_information":[{"code":"Px0000292189L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.6,"discounted_cash":429.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIALYSIS 14FR 15CM","code_information":[{"code":"Px0000292326L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE STR TPR 4FR 65CM","code_information":[{"code":"Px0000292485L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE STR TPR 5FR 100CM CG506","code_information":[{"code":"Px0000292486L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STRLG MR 4.0X20MMX80CM H74939031402080","code_information":[{"code":"Px0000292580L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STRLG MR 4.0X40MMX135CM 3903140401","code_information":[{"code":"Px0000292584L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STRLG MR 4.0X60MMX135CM","code_information":[{"code":"Px0000292585L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STRLG MR 5.0X40MMX135CM 3903150401","code_information":[{"code":"Px0000292598L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING MR 60X20X80","code_information":[{"code":"Px0000292608L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING MR 60X40X135 3903160401","code_information":[{"code":"Px0000292612L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE FATHOM-16 .016 180CM M001509110","code_information":[{"code":"Px0000293148L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.53,"discounted_cash":371.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC PRE-SHP 2TP 90D 150CM M0031681910","code_information":[{"code":"Px0000293236L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3833.06,"discounted_cash":1341.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 10X38X80 85420","code_information":[{"code":"Px0000293355L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROPUNCT 5FR NITNL/PLAT SST G43870","code_information":[{"code":"Px0000293604L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.94,"discounted_cash":41.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 7X40X135 1276804","code_information":[{"code":"Px0000293732L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"discounted_cash":118.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE STEEL CORE 18LT 018 300CM","code_information":[{"code":"Px0000293751L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 4X40X135","code_information":[{"code":"Px0000293759L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"discounted_cash":100.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 5X20X80 1275702","code_information":[{"code":"Px0000293763L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"discounted_cash":100.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PLUS PTA .035 6X40X135","code_information":[{"code":"Px0000293771L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.5,"discounted_cash":118.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX PTA 6.0 X 60 X 80CM","code_information":[{"code":"Px0000293772L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.5,"discounted_cash":100.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CRYO COAXIAL UMBILICAL","code_information":[{"code":"Px0000294097L","type":"CDM"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .018 X 90CM 518033","code_information":[{"code":"Px0000294460L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .018 X 135CM 518034","code_information":[{"code":"Px0000294461L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .035 X 90CM 518036","code_information":[{"code":"Px0000294462L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOS OMNI 3 5FR 80CM H787107204065","code_information":[{"code":"Px0000294813L","type":"CDM"}],"standard_charges":[{"gross_charge":85.85,"discounted_cash":30.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAABE 9FR .038 55CM RB G36393","code_information":[{"code":"Px0000294871L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXOR 9FR 70CM G12606","code_information":[{"code":"Px0000294872L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH LASER TURBO ELITE 1.7MM 417152","code_information":[{"code":"Px0000294924L","type":"CDM"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":11825.0,"discounted_cash":4138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT PROTEGE GPS 12X40 80CM SERB65124080","code_information":[{"code":"Px0000294995L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT PROTEGE GPS 12X60 80CM","code_information":[{"code":"Px0000294996L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT PROTEGE GPS 14X60 80CM","code_information":[{"code":"Px0000294997L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIOSEAL VIP 8F 610131","code_information":[{"code":"Px0000295175L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET NEFF ACCS CHIBA 21GA RH NT","code_information":[{"code":"Px0000295190L","type":"CDM"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE RUNWAY 6FR IM H74938969260","code_information":[{"code":"Px0000295487L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X40MM X 80CM PRB3508040080","code_information":[{"code":"Px0000295654L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH COBRA 1 SOFT-VU","code_information":[{"code":"Px0000295723L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.8,"discounted_cash":28.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE GRANDSLAM 300CM AG141302","code_information":[{"code":"Px0000296282L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":148.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIALYSIS 14F 20CM","code_information":[{"code":"Px0000296624L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TWIN-PASS DUAL ACCESS 014 5200","code_information":[{"code":"Px0000297219L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":600.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH LANGSTON DUAL PIG 6F 110C 5540","code_information":[{"code":"Px0000298588L","type":"CDM"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":239.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RENE 18 STR TIP 130/30","code_information":[{"code":"Px0000298590L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.67,"discounted_cash":558.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER AGILIS NXT 408309","code_information":[{"code":"Px0000298598L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4144.85,"discounted_cash":1450.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMOSTAR ALP CRV 14.5-28 5835230","code_information":[{"code":"Px0000299152L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.73,"discounted_cash":394.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X40MM X 120CM PRB3506040120","code_information":[{"code":"Px0000299198L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X60MM X 80CM PRB3508060080","code_information":[{"code":"Px0000299200L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RENEGADE 18 STR TIP 105/20","code_information":[{"code":"Px0000299668L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.67,"discounted_cash":558.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER AGILIS NXT MED 8.5F 408310","code_information":[{"code":"Px0000300012L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4144.85,"discounted_cash":1450.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 3MM X 6CM M001361500","code_information":[{"code":"Px0000300284L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.28,"discounted_cash":567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 4MMX8CM M001361520","code_information":[{"code":"Px0000300285L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.28,"discounted_cash":567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 5MMX8CM M001361540","code_information":[{"code":"Px0000300286L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.28,"discounted_cash":567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 5MMX15CM M001361550","code_information":[{"code":"Px0000300287L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.28,"discounted_cash":567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR DL 5FR 3275335","code_information":[{"code":"Px0000300348L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.95,"discounted_cash":147.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR SL 4FR","code_information":[{"code":"Px0000300349L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.95,"discounted_cash":164.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTIN 6FR 65CM RSP01","code_information":[{"code":"Px0000301944L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CABLE ELECTRICAL UMBILICAL","code_information":[{"code":"Px0000302244L","type":"CDM"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE SYNCHRO2 SFT 200 .014 M00326010","code_information":[{"code":"Px0000302455L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.24,"discounted_cash":784.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE SYNCHRO2 STD 200 .014 M00326410","code_information":[{"code":"Px0000302457L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.24,"discounted_cash":784.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE SYNCHRO2 STD CRV 200 .014 M00326420","code_information":[{"code":"Px0000302458L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2371.6,"discounted_cash":830.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH TRANSSEPTAL SLO 8.5 407451","code_information":[{"code":"Px0000302469L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.25,"discounted_cash":281.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOPSY TRIMARKTD2S13MR","code_information":[{"code":"Px0000302488L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":74.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TORNADO .035 6-3MM MWCE3563TORNADO","code_information":[{"code":"Px0000302588L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 4 X 320 SPD2US040320","code_information":[{"code":"Px0000302984L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":4882.5,"discounted_cash":1708.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 5 X 320 SPD2US050320","code_information":[{"code":"Px0000302986L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":4882.5,"discounted_cash":1708.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 6 X 320 SPD2US060320","code_information":[{"code":"Px0000302988L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":4882.5,"discounted_cash":1708.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 7 X 320 SPD2US070320","code_information":[{"code":"Px0000302990L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":4882.5,"discounted_cash":1708.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROPUNCT 4FR NITINOL G47942","code_information":[{"code":"Px0000303662L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.94,"discounted_cash":41.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X80MMX120CM PRB3506080120","code_information":[{"code":"Px0000303668L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X80MMX120CM PRB3507080120","code_information":[{"code":"Px0000303669L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT URO AMPLATZ 8.5FR 22CM G09708","code_information":[{"code":"Px0000303860L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.87,"discounted_cash":199.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT URO AMPLATZ 8.5FR 24CM G09709","code_information":[{"code":"Px0000303861L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.87,"discounted_cash":199.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X60MMX120CM PRB3506060120","code_information":[{"code":"Px0000304049L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 6 X 37MM X 80CM PXB350637080","code_information":[{"code":"Px0000304424L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 7 X 37MM X 80CM PXB350737080","code_information":[{"code":"Px0000304429L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 37MM X 80CM PXB350837080","code_information":[{"code":"Px0000304433L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 8 X 57MM X 80CM PXB350857080","code_information":[{"code":"Px0000304434L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROSPHERES LC 100-300 YELLOW VE220GS","code_information":[{"code":"Px0000304669L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8455.0,"discounted_cash":2959.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE WHSPR EXT SUPP .014X190CM 1011834H","code_information":[{"code":"Px0000304700L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE VBT 6FR 67019055","code_information":[{"code":"Px0000305265L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONTROLLER DETACHMENT 454001","code_information":[{"code":"Px0000305564L","type":"CDM"}],"standard_charges":[{"gross_charge":836.85,"discounted_cash":292.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PROGREAT 2.6 FR/110CM R/O","code_information":[{"code":"Px0000305650L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.5,"discounted_cash":537.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DEL TORQ 45 AMPLATZER 8F 9ITV08F4580","code_information":[{"code":"Px0000305653L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":3211.2,"discounted_cash":1123.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO PUSH AZUR .018 3X2","code_information":[{"code":"Px0000305937L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.25,"discounted_cash":245.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI HERCU 5X15MMX135CM 101149315","code_information":[{"code":"Px0000306470L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT HERCULINK ELT 4X18X135 101148718","code_information":[{"code":"Px0000306480L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 5X100MMX120CM PRB3505100120","code_information":[{"code":"Px0000306791L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .014 X 150CM 518065","code_information":[{"code":"Px0000306847L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH QUICK CROSS .035 X 150CM 518038","code_information":[{"code":"Px0000306849L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET THRMBCTMY SPIRO 4F 135CM 106553001","code_information":[{"code":"Px0000306902L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7425.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KIT SNARE GN 6FR 20MM GN2000","code_information":[{"code":"Px0000307091L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.75,"discounted_cash":389.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DEST PINN 7FR 65CM RSP02","code_information":[{"code":"Px0000307133L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ROSEN 035 145CM 1.5M","code_information":[{"code":"Px0000307135L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.61,"discounted_cash":17.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN GATEWAY OTW 2.00 X 9 MM","code_information":[{"code":"Px0000307373L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.1,"discounted_cash":1528.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN GTWAY 2.50X9MM M0032072209250","code_information":[{"code":"Px0000307375L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.1,"discounted_cash":1528.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PRE-SHAPE J 150 6CM M0031681920","code_information":[{"code":"Px0000307434L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3833.06,"discounted_cash":1341.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC PRE-SHP 2TP 45D 150CM M0031681900","code_information":[{"code":"Px0000307435L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3833.06,"discounted_cash":1341.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER PUNCTURE MICRO STIF G48008","code_information":[{"code":"Px0000307502L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.88,"discounted_cash":69.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO 5FR AMPLATZ L1 H74908526962","code_information":[{"code":"Px0000307553L","type":"CDM"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE GHIATAS STIFFENED 9CM","code_information":[{"code":"Px0000307803L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.01,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 COIL 864017","code_information":[{"code":"Px0000307940L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.95,"discounted_cash":134.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TORCON NB 5.0FX65CM LEV1 G11194","code_information":[{"code":"Px0000308224L","type":"CDM"}],"standard_charges":[{"gross_charge":79.84,"discounted_cash":27.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FLUSH 5FR 70CM .035 PIG","code_information":[{"code":"Px0000308240L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 4FR .038 40CM KMP","code_information":[{"code":"Px0000308282L","type":"CDM"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 4FR .038 65CM KMP","code_information":[{"code":"Px0000308285L","type":"CDM"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 40CM KMP","code_information":[{"code":"Px0000308297L","type":"CDM"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR .038 65CM KMP","code_information":[{"code":"Px0000308300L","type":"CDM"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET NEFF ACCESS CHIBA 21GA NT G08426","code_information":[{"code":"Px0000308328L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.55,"discounted_cash":123.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT URO MACLOC 8.5FR 22CM G48173","code_information":[{"code":"Px0000308338L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.55,"discounted_cash":163.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL1 5FR 018/038 45CM G29981","code_information":[{"code":"Px0000308385L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL0 6FR 018/038 45CM G44154","code_information":[{"code":"Px0000308387L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL0 7FR 018/038 45CM G44155","code_information":[{"code":"Px0000308389L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL1 6FR 018/038 55CM","code_information":[{"code":"Px0000308396L","type":"CDM"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL1 7FR 018/038 55CM","code_information":[{"code":"Px0000308398L","type":"CDM"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PEELWY 16FR .038 30CM G02950","code_information":[{"code":"Px0000308405L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.19,"discounted_cash":92.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH W/ WIRE 14FR .038 13CM G08024","code_information":[{"code":"Px0000308407L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.94,"discounted_cash":74.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROPUNCT 5FR SS/PLAT USOUND","code_information":[{"code":"Px0000308436L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.57,"discounted_cash":41.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 038 145CM COO G02324","code_information":[{"code":"Px0000308582L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.99,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE .025 260CM 3MM G00471","code_information":[{"code":"Px0000308587L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.27,"discounted_cash":25.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PORT POWER PORT 8FR 1808060","code_information":[{"code":"Px0000308937L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.65,"discounted_cash":497.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX SV .018 3X40X150","code_information":[{"code":"Px0000308984L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 3MMX12CM M001361510","code_information":[{"code":"Px0000309287L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.28,"discounted_cash":567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 2D HELICAL 4MMX15CM M001361530","code_information":[{"code":"Px0000309288L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.28,"discounted_cash":567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI WSTNT UNCVR 10X60M M00570640","code_information":[{"code":"Px0000309423L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6670.0,"discounted_cash":2334.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WALLSTENT MV UNCOVERED 10X80 M00570650","code_information":[{"code":"Px0000309424L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6670.0,"discounted_cash":2334.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DRAIN MACLOC 10.2FX40 G13353","code_information":[{"code":"Px0000309662L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.28,"discounted_cash":126.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT XIENCE RX 2.5X12MM 100953912","code_information":[{"code":"Px0000309956L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1712.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DESTINATION SHEAT 5F 45CM 5454501","code_information":[{"code":"Px0000309991L","type":"CDM"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT MICROPUNCTURE TRANS SS 4F","code_information":[{"code":"Px0000310057L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.94,"discounted_cash":38.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 8X38X120 85416","code_information":[{"code":"Px0000311045L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 7X5X120 VBH070502","code_information":[{"code":"Px0000311518L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6962.5,"discounted_cash":2436.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 8X5X120 VBH080502","code_information":[{"code":"Px0000311521L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7487.5,"discounted_cash":2620.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT URO FLXMA PGTL 8FR 22CM","code_information":[{"code":"Px0000311625L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TRANSEND STEERBL 2CM","code_information":[{"code":"Px0000311626L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.56,"discounted_cash":275.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FLOW DIRECT PACING RT HEART 401763","code_information":[{"code":"Px0000311873L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SAFIRE BI MED CURL 4MM 402810","code_information":[{"code":"Px0000311881L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":2837.25,"discounted_cash":993.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE .035 180CM STR GR3503","code_information":[{"code":"Px0000312725L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.79,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLEXOR ANSEL GUIDING SHEATH G49099","code_information":[{"code":"Px0000313032L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PRONTO LP EXTRACT 5010","code_information":[{"code":"Px0000313645L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER KIT G48007","code_information":[{"code":"Px0000313768L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.88,"discounted_cash":66.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STARCLOSE SE VCS 1467901","code_information":[{"code":"Px0000313775L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PROGRT 2.4F W/MKR MCPB2413Y","code_information":[{"code":"Px0000313787L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.5,"discounted_cash":537.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH INTRO VASC MICPUNC 5FR 10 G36333","code_information":[{"code":"Px0000313796L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.94,"discounted_cash":38.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT URO FLXMA PGTL 8FR 26CM M001274030","code_information":[{"code":"Px0000314036L","type":"CDM"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC G WIRE FIELDER ASAHI 180 8235901","code_information":[{"code":"Px0000314120L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X22X80 85443","code_information":[{"code":"Px0000314763L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FEM COMPRESSION WITH MANOMETER C11165","code_information":[{"code":"Px0000314807L","type":"CDM"}],"standard_charges":[{"gross_charge":424.5,"discounted_cash":148.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TISSUE MARKER WING ULTRACLP II 862017D","code_information":[{"code":"Px0000314848L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.43,"discounted_cash":110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ATLAS 4X16 75CM AT75164","code_information":[{"code":"Px0000317278L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING 4.0 X 40 X 137 20764040","code_information":[{"code":"Px0000317438L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4512.5,"discounted_cash":1579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING 5.0 X 40 X 137 20765040","code_information":[{"code":"Px0000317439L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4512.5,"discounted_cash":1579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE 014 WHISPER ES300 P3 1011835H","code_information":[{"code":"Px0000317700L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PIGTAIL SOFT VU 6FR 110CM","code_information":[{"code":"Px0000317995L","type":"CDM"}],"standard_charges":[{"gross_charge":80.8,"discounted_cash":28.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL LOC WIRE 20GX5CM","code_information":[{"code":"Px0000318459L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.01,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER ACCUSTICK II/J TIP M001207040","code_information":[{"code":"Px0000318478L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.9,"discounted_cash":103.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE DC LUNDERQUIST EXTRA STIF G45208","code_information":[{"code":"Px0000318733L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE ENVOY 5FR 100CM 55625600","code_information":[{"code":"Px0000318763L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.6,"discounted_cash":658.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CRAGG INF 4FR 135X20CM 4104201","code_information":[{"code":"Px0000320399L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":133.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE SYNCRO .014 200CM M00313020","code_information":[{"code":"Px0000323134L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2454.1,"discounted_cash":858.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HERMETIC LUMBAR CLSD TIP INS5010","code_information":[{"code":"Px0000324582L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EZ-STEER BI-DIRECT D-F BN7TCDF4L","code_information":[{"code":"Px0000324800L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":9328.0,"discounted_cash":3264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 6X22 120CM 85453","code_information":[{"code":"Px0000326891L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE CORDIS 6FR JL3 67000000","code_information":[{"code":"Px0000327417L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.4,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLUDER AMPLATZER SEPTAL 15MM 9ASD015","code_information":[{"code":"Px0000327894L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":28303.8,"discounted_cash":9906.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FOUNTAIN INF 5FR 135X20CM","code_information":[{"code":"Px0000328696L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":100.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SPRINTER LEGEND RX 1.5X6 SPL15006X","code_information":[{"code":"Px0000328712L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE FIELDER FC 180CM AGP140001 AGP140001","code_information":[{"code":"Px0000329247L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ASHAI XT .014 190CM AGP140002","code_information":[{"code":"Px0000329248L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL LOCALIZATN GHIATAS 20GX7CM","code_information":[{"code":"Px0000329250L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.61,"discounted_cash":28.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT INTRODUCER MICKEY G-18 98433","code_information":[{"code":"Px0000330024L","type":"CDM"}],"standard_charges":[{"gross_charge":994.95,"discounted_cash":348.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.0 X 12 H7493895912200","code_information":[{"code":"Px0000330678L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.5 X 12 H7493895912250","code_information":[{"code":"Px0000330680L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 3.0 X 12 H7493895912300","code_information":[{"code":"Px0000330682L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.5 X 15 H7493895915250","code_information":[{"code":"Px0000330692L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CRAN WINGSPAN 3.5X15MM","code_information":[{"code":"Px0000330733L","type":"CDM"}],"standard_charges":[{"gross_charge":23266.32,"discounted_cash":8143.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG CRN RADIO CRV INTER MAM EXPO TRI PLY 5FRX100CM H749085262012","code_information":[{"code":"Px0000331211L","type":"CDM"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING 4X2X135 RX","code_information":[{"code":"Px0000332264L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE EXCHANGE BENTSON M001491481","code_information":[{"code":"Px0000332270L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACEMAKER ADAPTA DR ADDRL1","code_information":[{"code":"Px0000333703L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":7956.25,"discounted_cash":2784.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 6MMX10CM HELICAL 36-156 M001361560","code_information":[{"code":"Px0000334665L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.28,"discounted_cash":567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT WINGSPAN 3.0X20MM M003WS0300200","code_information":[{"code":"Px0000334671L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":23266.32,"discounted_cash":8143.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT WINGSPAN 4.5 X 20MM","code_information":[{"code":"Px0000334672L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":23266.32,"discounted_cash":8143.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER SHEATH 20FR 261336 G12830","code_information":[{"code":"Px0000335057L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1759.1,"discounted_cash":615.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PIG 145 DEG 5FRX100CM H74908526412","code_information":[{"code":"Px0000336006L","type":"CDM"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EXPO 5FR PIGTAIL","code_information":[{"code":"Px0000336007L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RENEGADE STC ST M001181370","code_information":[{"code":"Px0000336675L","type":"CDM"}],"standard_charges":[{"gross_charge":1596.67,"discounted_cash":558.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WALLSTNT ESOPH PARTCVR23X28X12 M00516940","code_information":[{"code":"Px0000336809L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7425.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROCATH EXCELSIOR SL-10 M0031681930","code_information":[{"code":"Px0000338168L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3833.06,"discounted_cash":1341.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOPROSTHESIS VIABIL BILIARY","code_information":[{"code":"Px0000338490L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11807.8,"discounted_cash":4132.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 5X120MMX120CM PRB3505120120","code_information":[{"code":"Px0000341645L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X40MMX80CM PRB3507040080","code_information":[{"code":"Px0000342686L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X60MMX120CM PRB3508060120","code_information":[{"code":"Px0000343001L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X80MMX120CM PRB3508080120","code_information":[{"code":"Px0000343002L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC POWER TRIALYSIS TEMP 20CM CURV 5613200","code_information":[{"code":"Px0000343406L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.48,"discounted_cash":221.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC POWER TRIALYSIS TEMP 30CM STRA","code_information":[{"code":"Px0000343407L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.88,"discounted_cash":207.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC POWER TRIALYSIS TEMP 15CM CURV 5613150","code_information":[{"code":"Px0000343418L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.45,"discounted_cash":291.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EZ-STEER BI-DIRECT 8M F-J BN7TCFJ8L","code_information":[{"code":"Px0000344736L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":11549.8,"discounted_cash":4042.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE VERSACORE MOD J 145CM 101206801","code_information":[{"code":"Px0000346515L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE VERSACORE FLOPPY 175CM 101206804","code_information":[{"code":"Px0000346520L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC JAGWIRE ANGLED STIFF .025IN M00556491","code_information":[{"code":"Px0000346527L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.05,"discounted_cash":170.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET THROMBECTOMY AVX 6F 50CM 105039001","code_information":[{"code":"Px0000347125L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.25,"discounted_cash":1060.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 7122Q52","code_information":[{"code":"Px0000347163L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X120MMX150CM AB14W025120150","code_information":[{"code":"Px0000347400L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X150MMX135CM AB35W06150135","code_information":[{"code":"Px0000347564L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SHEATH ANSEL 5FR X 45CM","code_information":[{"code":"Px0000347578L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE X-CELER EXCH 10 1030601300","code_information":[{"code":"Px0000347679L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":358.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM 3D 2MM X 2CM QC223D","code_information":[{"code":"Px0000347680L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3720.0,"discounted_cash":1302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM 3D 2MM X 4CM QC243D","code_information":[{"code":"Px0000347681L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3720.0,"discounted_cash":1302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DETACHER COIL AXIUM 5/BOX ID15","code_information":[{"code":"Px0000347736L","type":"CDM"}],"standard_charges":[{"gross_charge":245.43,"discounted_cash":85.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXOR GUIDE KCFW6.0 G08681","code_information":[{"code":"Px0000348004L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.6,"discounted_cash":87.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ASHAI XT .014 300CM AGP140302","code_information":[{"code":"Px0000348119L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X100MMX135CM AB35W05100135","code_information":[{"code":"Px0000348129L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI WFLX 8.5FR 10X60MM 7053","code_information":[{"code":"Px0000349186L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2537.5,"discounted_cash":888.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EKOSONIC MACH4 135CM 12CM 50056112","code_information":[{"code":"Px0000349212L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":12878.5,"discounted_cash":4507.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOSHIELD NAV6 5.0MM 2243719","code_information":[{"code":"Px0000349375L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.8,"discounted_cash":2395.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOSHIELD NAV6 7.2MM 2243819","code_information":[{"code":"Px0000349376L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.8,"discounted_cash":2395.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION 8F 45CM 5484501","code_information":[{"code":"Px0000349409L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOPSY SITE 1ST SMARKEVIVA13","code_information":[{"code":"Px0000349450L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.55,"discounted_cash":88.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOP SECURMARK EVIVA 2 SMARKEVIVA2S13","code_information":[{"code":"Px0000349452L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.55,"discounted_cash":88.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL HAWKINS I 251050","code_information":[{"code":"Px0000350067L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.66,"discounted_cash":76.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC  CATH SHERPA ACTIVE 6F EBU3.5","code_information":[{"code":"Px0000350135L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":79.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SHERPA ACTIVE 6FR EBU4.0","code_information":[{"code":"Px0000350141L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":79.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT URO MACLOC 8.5FR 24CM G48176","code_information":[{"code":"Px0000350181L","type":"CDM"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.55,"discounted_cash":163.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 180CM 3J AES G03565","code_information":[{"code":"Px0000350347L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.54,"discounted_cash":27.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN HEP 10X5X120","code_information":[{"code":"Px0000350740L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7487.5,"discounted_cash":2620.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL HAWKINS 20GAX7.5CM 251075","code_information":[{"code":"Px0000350810L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.66,"discounted_cash":76.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DL HAWKINS 20GAX10.0CM","code_information":[{"code":"Px0000350811L","type":"CDM"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.66,"discounted_cash":76.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT CHEST TUBE CATH PLEURX SYS 507000B","code_information":[{"code":"Px0000351011L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.25,"discounted_cash":1060.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER BX TRIMARK HRGLASS 130MM TRIMARKEVIVA2S13","code_information":[{"code":"Px0000351096L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.1,"discounted_cash":59.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING 6.0 X 40 X 137 20766040","code_information":[{"code":"Px0000351166L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4512.5,"discounted_cash":1579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSLXC","code_information":[{"code":"Px0000351173L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":7290.0,"discounted_cash":2551.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THLXM","code_information":[{"code":"Px0000351175L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":12685.0,"discounted_cash":4439.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO-GUIDE FINECROSS 351430","code_information":[{"code":"Px0000351348L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2082.5,"discounted_cash":728.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE 38X150 G30473","code_information":[{"code":"Px0000351605L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.22,"discounted_cash":58.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TAL PALINDROME 14.5X23CM 8888145048","code_information":[{"code":"Px0000353372L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":7500.0,"discounted_cash":2625.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TAL PALINDROME 14.5X19CM 8888145057","code_information":[{"code":"Px0000353374L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":9228.48,"discounted_cash":3229.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR SOLO SL 4FR KT","code_information":[{"code":"Px0000353578L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR SOLO DL 5FR KT","code_information":[{"code":"Px0000353579L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.16,"discounted_cash":139.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 9 X 37MM X 80CM PXB350937080","code_information":[{"code":"Px0000354057L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXOR GUIDE 7FR 13CM G11211","code_information":[{"code":"Px0000354341L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.6,"discounted_cash":87.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ULTRACLIP BARD TRIGGER RIBBON 17G 863017D","code_information":[{"code":"Px0000354970L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.43,"discounted_cash":110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ULTRACLIP BARD TRIGGER COIL 864017D","code_information":[{"code":"Px0000354971L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.43,"discounted_cash":110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC SOLO SL 4FR 55CM TY 9194108D","code_information":[{"code":"Px0000355033L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.84,"discounted_cash":255.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUSION 054 136CM PSC054","code_information":[{"code":"Px0000355039L","type":"CDM"}],"standard_charges":[{"gross_charge":6693.0,"discounted_cash":2342.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYS EN SNARE 6FR CATH 9-15MM EN2006015","code_information":[{"code":"Px0000355556L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.03,"discounted_cash":562.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYS EN SNARE 7FR CATH 27-45MM EN2007045","code_information":[{"code":"Px0000355559L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.03,"discounted_cash":562.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE NITREX .018 80CM N180801","code_information":[{"code":"Px0000355637L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE NITREX .014 80CM N140801","code_information":[{"code":"Px0000355638L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 180CM GA3501","code_information":[{"code":"Px0000355901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DREAMTOME RX44 20MM M00584040","code_information":[{"code":"Px0000356272L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1957.99,"discounted_cash":685.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VALVE HEMOSTASIS W/INSERT TOOL 8210","code_information":[{"code":"Px0000356361L","type":"CDM"}],"standard_charges":[{"gross_charge":178.57,"discounted_cash":62.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH NEURON SELECT 5F 130 SIM PNS5F130SIM","code_information":[{"code":"Px0000356456L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH NEURON SELECT 5F 130 BER PNS5F130BER","code_information":[{"code":"Px0000356457L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PRWLR PLUS ST2 2.8F150 20 6062510","code_information":[{"code":"Px0000356511L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3619.46,"discounted_cash":1266.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH 5F INF. 100CM BERENSTEIN SRD5839","code_information":[{"code":"Px0000356520L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":175.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL1 7FR 018/038 45CM G29985","code_information":[{"code":"Px0000356844L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VIPER ADV.014-.014 VPRGW14","code_information":[{"code":"Px0000356861L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROCATH REN HIFLO 150/20CM M001182910","code_information":[{"code":"Px0000357084L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1426.99,"discounted_cash":499.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 260CM GA3502","code_information":[{"code":"Px0000357228L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAMP 18MM CRV 8.5F 406965","code_information":[{"code":"Px0000357339L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.25,"discounted_cash":281.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH AGILIS CURL LG 8.5F G408324","code_information":[{"code":"Px0000357340L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4144.85,"discounted_cash":1450.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FOX SV .018 5X120X150","code_information":[{"code":"Px0000357352L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT 1ST FX EXPRESS 15/2 CDS KPE1003CDS","code_information":[{"code":"Px0000357462L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9680.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ATLAS 7FR 12X4 120CM AT120124","code_information":[{"code":"Px0000357609L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FILTER CELECT JUGULAR 65CM","code_information":[{"code":"Px0000357680L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.0,"discounted_cash":874.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT ANCHR MIC SAF-T-PEXY FSTNR 98701","code_information":[{"code":"Px0000357957L","type":"CDM"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DREAMWIRE .035IN 450CM STR M00556161","code_information":[{"code":"Px0000357964L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ATTAIN LV 419688","code_information":[{"code":"Px0000358163L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.47,"discounted_cash":1649.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG ACUNAV 8F 90CM 10135936","code_information":[{"code":"Px0000358190L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":10857.5,"discounted_cash":3800.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRAY CATH TRIALYSIS CRV 15CM 5615150","code_information":[{"code":"Px0000358201L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.49,"discounted_cash":280.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDELINER 6F 20/135CM 5571","code_information":[{"code":"Px0000358350L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.1,"discounted_cash":667.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDELINER 8F 20/135CM 5573","code_information":[{"code":"Px0000358352L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.1,"discounted_cash":667.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PORT POWER VACCESS 8F","code_information":[{"code":"Px0000359223L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 7X80MMX75CM CQ7578","code_information":[{"code":"Px0000359525L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 14FR 038 30CM G08957","code_information":[{"code":"Px0000359795L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.25,"discounted_cash":171.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ATLAS 8FR 16X40MMX120CM AT120164","code_information":[{"code":"Px0000359840L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RENEGADE STC 18 150/30","code_information":[{"code":"Px0000360076L","type":"CDM"}],"standard_charges":[{"gross_charge":1671.52,"discounted_cash":585.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PATCH EXTERNAL REF CARTO3 CREFP6","code_information":[{"code":"Px0000360347L","type":"CDM"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRAY CATH TRIALYSIS ST 20CM 5605200","code_information":[{"code":"Px0000360358L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.04,"discounted_cash":270.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL TIG 5F 1.7X100 405011","code_information":[{"code":"Px0000360568L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL JACKY 5F 1.7X100 405021","code_information":[{"code":"Px0000360569L","type":"CDM"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE RUNTHRU .014X180X3 251011","code_information":[{"code":"Px0000360570L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ABLA NAV EZ 4MM F/J CRV BN7TCFJ4L","code_information":[{"code":"Px0000360844L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":9328.0,"discounted_cash":3264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH GUIDE GLEXOR ANSEL 90CM","code_information":[{"code":"Px0000361116L","type":"CDM"}],"standard_charges":[{"gross_charge":504.4,"discounted_cash":176.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET FILTER FEMORAL CELECT G52914","code_information":[{"code":"Px0000361117L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":3000.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FILTER CAVA JUG TULIP VENA G52916","code_information":[{"code":"Px0000361118L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":4177.06,"discounted_cash":1461.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FILTER CAVA FEM TULIP VENA G52917","code_information":[{"code":"Px0000361119L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":4177.06,"discounted_cash":1461.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG ACUNAV 8F 90CM -REP 10135936RH","code_information":[{"code":"Px0000361283L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":3956.66,"discounted_cash":1384.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.0 X 8 H7493912408200","code_information":[{"code":"Px0000361834L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.50 X 8 H7493912408250","code_information":[{"code":"Px0000361836L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.0 X 8 H7493912408300","code_information":[{"code":"Px0000361838L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.25 X 8 H7493912408320","code_information":[{"code":"Px0000361839L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.50 X 8 H7493912408350","code_information":[{"code":"Px0000361840L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.75 X 8 H7493912408370","code_information":[{"code":"Px0000361841L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.0 X 8 H7493912408400","code_information":[{"code":"Px0000361842L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.50 X 8 H7493912408450","code_information":[{"code":"Px0000361843L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.0 X 12 H7493912412200","code_information":[{"code":"Px0000361845L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.50 X 12 H7493912412250","code_information":[{"code":"Px0000361847L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.0 X 12 H7493912412300","code_information":[{"code":"Px0000361849L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.25 X 12 H7493912412320","code_information":[{"code":"Px0000361850L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.50 X 12 H7493912412350","code_information":[{"code":"Px0000361851L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.0 X 12 H7493912412400","code_information":[{"code":"Px0000361853L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.50 X 12 H7493912412450","code_information":[{"code":"Px0000361854L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 5.0 X 12 H7493912412500","code_information":[{"code":"Px0000361855L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.75 X 15 H7493912415270","code_information":[{"code":"Px0000361859L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.25 X 15 H7493912415320","code_information":[{"code":"Px0000361861L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.50 X 15 H7493912415350","code_information":[{"code":"Px0000361862L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.75 X 15 H7493912415370","code_information":[{"code":"Px0000361863L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.0 X 15 H7493912415400","code_information":[{"code":"Px0000361864L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.50 X 20 H7493912420250","code_information":[{"code":"Px0000361869L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.0 X 20 H7493912420300","code_information":[{"code":"Px0000361871L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM 4.0 X 20 H7493912420400","code_information":[{"code":"Px0000361875L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BERENSTEIN 5F 100CM H787107227035","code_information":[{"code":"Px0000362497L","type":"CDM"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC DEST 6FR 90CM STR RSC05","code_information":[{"code":"Px0000362764L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CHECK-FLO 10F .038 30CM","code_information":[{"code":"Px0000362825L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.5,"discounted_cash":99.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER PEG KIT 20FR","code_information":[{"code":"Px0000362844L","type":"CDM"}],"standard_charges":[{"gross_charge":485.5,"discounted_cash":169.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE FATHOM .016INX180CM","code_information":[{"code":"Px0000363269L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.7,"discounted_cash":208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANGLE STD .035X180","code_information":[{"code":"Px0000364202L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.57,"discounted_cash":73.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 2.5X210MMX150CM AB14W025210150","code_information":[{"code":"Px0000364288L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X210MMX150CM AB14W030210150","code_information":[{"code":"Px0000364289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 3.5X210MMX150CM AB14W035210150","code_information":[{"code":"Px0000364290L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X210MMX150CM AB14W040210150","code_information":[{"code":"Px0000364291L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X150MMX150CM AB14W020150150","code_information":[{"code":"Px0000364292L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 2.5X150MMX150CM AB14W025150150","code_information":[{"code":"Px0000364293L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 3.0X150MMX150CM AB14W030150150","code_information":[{"code":"Px0000364294L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 4.0X150MMX150CM AB14W040150150","code_information":[{"code":"Px0000364296L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE FATHOM .014 200CM M001508100","code_information":[{"code":"Px0000364351L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.26,"discounted_cash":419.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SWAN GANZ 6FR 110CM  096F6P","code_information":[{"code":"Px0000364438L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDE ENVOY 5FR 100CM MPD 55625800","code_information":[{"code":"Px0000364732L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.6,"discounted_cash":658.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVUS EAGLE EYE PLATINUM 85900P","code_information":[{"code":"Px0000364771L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.2,"discounted_cash":1224.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X60MMX80CM PRB3507060080","code_information":[{"code":"Px0000365165L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI EVRFLX 8X80MMX80CM PRB3508080080","code_information":[{"code":"Px0000365167L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT PROTEGE 12X80MMX80CM SERB65128080","code_information":[{"code":"Px0000365169L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CRAN NEUROFRM3 EZ 3X20MM","code_information":[{"code":"Px0000365218L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":13585.0,"discounted_cash":4754.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X150MMX135CM AB35W05150135","code_information":[{"code":"Px0000365459L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X200MMX135CM AB35W05200135","code_information":[{"code":"Px0000365460L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 6.0X8X135 AB35W06080135","code_information":[{"code":"Px0000365464L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X100MMX135CM AB35W06100135","code_information":[{"code":"Px0000365465L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X200MMX135CM AB35W06200135","code_information":[{"code":"Px0000365466L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X60MMX80CM AB35W05060080","code_information":[{"code":"Px0000365480L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X80MMX80CM AB35W05080080","code_information":[{"code":"Px0000365481L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 5.0X10X80 AB35W05100080","code_information":[{"code":"Px0000365482L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X40MMX80CM AB35W06040080","code_information":[{"code":"Px0000365486L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 7X60MMX80CM AB35W07060080","code_information":[{"code":"Px0000365490L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 7X80MMX80CM AB35W07080080","code_information":[{"code":"Px0000365491L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 7.0X10X80 AB35W07100080","code_information":[{"code":"Px0000365492L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X40MMX80CM AB35W08040080","code_information":[{"code":"Px0000365497L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 8.0X6X80 AB35W08060080","code_information":[{"code":"Px0000365500L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 8.0X8X80 AB35W08080080","code_information":[{"code":"Px0000365501L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 10X40MMX80CM AB35W10040080","code_information":[{"code":"Px0000365508L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 10.0X6X80 AB35W10060080","code_information":[{"code":"Px0000365509L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 12X40MMX80CM AB35W12040080","code_information":[{"code":"Px0000365510L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PROGRT 2.8FR 130CM MCPE28131YB","code_information":[{"code":"Px0000365783L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2522.0,"discounted_cash":882.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYS COIL DEL DCS TRUFILL SYR 635002","code_information":[{"code":"Px0000366075L","type":"CDM"}],"standard_charges":[{"gross_charge":1389.96,"discounted_cash":486.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEART TRAIL 3 6FR TIGMOD 4.0 406311","code_information":[{"code":"Px0000366150L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 9 X 57MM X 80CM PXB35-09-57-080 PXB350957080","code_information":[{"code":"Px0000366297L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER HYDROMARK BRST 15GA 3 40100215T3","code_information":[{"code":"Px0000366500L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER HYDROMARK BRST 12GA 3","code_information":[{"code":"Px0000366501L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.5,"discounted_cash":72.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH ANSEL 5FR 90CM G48189","code_information":[{"code":"Px0000366551L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.4,"discounted_cash":176.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPPORT CXI ST .035X90CM 4FR G52546","code_information":[{"code":"Px0000366766L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.05,"discounted_cash":267.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPPORT CXI ST .035 135CM 4FR G52542","code_information":[{"code":"Px0000366767L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.05,"discounted_cash":267.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPPORT CXI ANG.035X135CM 4FR G52543","code_information":[{"code":"Px0000366768L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.05,"discounted_cash":267.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE AMPLATZ .038X145CM","code_information":[{"code":"Px0000367174L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.1,"discounted_cash":52.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH 8FR 65CM DESTINATION 5486501","code_information":[{"code":"Px0000367178L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 10X38X120 85424","code_information":[{"code":"Px0000367327L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ACCESS KIT SCREEN SNAP LID SCS 355531","code_information":[{"code":"Px0000367889L","type":"CDM"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PRELUDE PRO 6F 11CM PRO6F11035","code_information":[{"code":"Px0000368150L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.46,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROPUNCTURE SET STIFF 5FR MR190511","code_information":[{"code":"Px0000368313L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":53.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CV PRESS INJ 3L 7FR 20CM CDC45703XP1A","code_information":[{"code":"Px0000368960L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.4,"discounted_cash":163.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH SHUTTLE 6F/80CM G13539","code_information":[{"code":"Px0000369324L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.98,"discounted_cash":175.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X08MM 101227208","code_information":[{"code":"Px0000369641L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X12MM 101227212","code_information":[{"code":"Px0000369642L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X15MM 101227215","code_information":[{"code":"Px0000369643L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 2.50X20MM 101227220","code_information":[{"code":"Px0000369644L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 3.0X12MM 101227412","code_information":[{"code":"Px0000369656L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 3.0X15MM 101227415","code_information":[{"code":"Px0000369657L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 3.0X20MM 101227420","code_information":[{"code":"Px0000369658L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 3.50X12MM 101227612","code_information":[{"code":"Px0000369670L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 3.50X15MM 101227615","code_information":[{"code":"Px0000369671L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 4.0X15MM 101227815","code_information":[{"code":"Px0000369685L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 4.0X20MM 101227820","code_information":[{"code":"Px0000369686L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TREK RX 5.0X15MM 101228015","code_information":[{"code":"Px0000369692L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X40X150 A2020040","code_information":[{"code":"Px0000369832L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X80X150 A2020080","code_information":[{"code":"Px0000369834L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X120X150 A2020120","code_information":[{"code":"Px0000369835L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 2.0X200X150 A2020200","code_information":[{"code":"Px0000369836L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X40X150 A2030040","code_information":[{"code":"Px0000369842L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X80X150 A2030080","code_information":[{"code":"Px0000369844L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X120X150 A2030120","code_information":[{"code":"Px0000369845L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 3.0X200X150 A2030200","code_information":[{"code":"Px0000369846L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X40X150 A2040040","code_information":[{"code":"Px0000369848L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X80X150 A2040080","code_information":[{"code":"Px0000369849L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X120X150 A2040120","code_information":[{"code":"Px0000369850L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMADA .014 4.0X200X150 A2040200","code_information":[{"code":"Px0000369851L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X06MM 101226906","code_information":[{"code":"Px0000370225L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X08MM 101226908","code_information":[{"code":"Px0000370226L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X12MM 101226912","code_information":[{"code":"Px0000370227L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 1.50X15MM 101226915","code_information":[{"code":"Px0000370228L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X08MM 101227008","code_information":[{"code":"Px0000370231L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X12MM 101227012","code_information":[{"code":"Px0000370232L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X15MM 101227015","code_information":[{"code":"Px0000370233L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X20MM 101227020","code_information":[{"code":"Px0000370234L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK RX 2.0X25MM 101227025","code_information":[{"code":"Px0000370235L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT ELECTRODE NAVX VELOCITY","code_information":[{"code":"Px0000370326L","type":"CDM"}],"standard_charges":[{"gross_charge":4859.25,"discounted_cash":1700.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X210MMX150CM AB14W020210150","code_information":[{"code":"Px0000370695L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMO TITAN STR 15.5F 24CM","code_information":[{"code":"Px0000371657L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMO TITAN 15.5F 28CM","code_information":[{"code":"Px0000371658L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMO TITAN 15.5F 32CM","code_information":[{"code":"Px0000371659L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARTRIDGE CEMENT KYPHO CC02A","code_information":[{"code":"Px0000372217L","type":"CDM"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":79.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 712265","code_information":[{"code":"Px0000372383L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT WALLFLEX 10X80 PC M00570740","code_information":[{"code":"Px0000372402L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7787.5,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT TRACH ICAST CVR 6X38X120 85412","code_information":[{"code":"Px0000372599L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSXC","code_information":[{"code":"Px0000372995L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":12685.0,"discounted_cash":4439.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSSC","code_information":[{"code":"Px0000372996L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":7290.0,"discounted_cash":2551.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIOJET SOLENT 6FR 90CM 109676001","code_information":[{"code":"Px0000373166L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":6808.0,"discounted_cash":2382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 2.0X12MM 101244512","code_information":[{"code":"Px0000373169L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 2.0X20MM 101244520","code_information":[{"code":"Px0000373171L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 2.25X15MM 101244615","code_information":[{"code":"Px0000373174L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 2.5X12MM 101244712","code_information":[{"code":"Px0000373177L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.0X8MM 101244908","code_information":[{"code":"Px0000373185L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.0X20MM 101244920","code_information":[{"code":"Px0000373188L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.25X12MM 101245012","code_information":[{"code":"Px0000373190L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X8MM 101245108","code_information":[{"code":"Px0000373192L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X12MM 101245112","code_information":[{"code":"Px0000373193L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X15MM 101245115","code_information":[{"code":"Px0000373194L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X20MM 101245120","code_information":[{"code":"Px0000373195L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.75X15MM 101245215","code_information":[{"code":"Px0000373198L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X8MM 101245308","code_information":[{"code":"Px0000373200L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X12MM 101245312","code_information":[{"code":"Px0000373201L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X15MM 101245315","code_information":[{"code":"Px0000373202L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 4.5X12MM 101245412","code_information":[{"code":"Px0000373203L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 5.0X12MM 101245512","code_information":[{"code":"Px0000373204L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.25X20MM 101245020","code_information":[{"code":"Px0000373279L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 3.5X25MM 101245125","code_information":[{"code":"Px0000373281L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 4.0X20MM 101245320","code_information":[{"code":"Px0000373282L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC TREK 5.0X15MM 101245515","code_information":[{"code":"Px0000373287L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 2MMX4CM M0035472040 M0035472040","code_information":[{"code":"Px0000373402L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 3MMX6CM M0035473060 M0035473060","code_information":[{"code":"Px0000373403L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 3MMX8CM M0035473080 M0035473080","code_information":[{"code":"Px0000373404L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 4MMX8CM M0035474080","code_information":[{"code":"Px0000373406L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 4MMX10CM M0035474100","code_information":[{"code":"Px0000373407L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 5MMX10CM M0035475100","code_information":[{"code":"Px0000373408L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 5MMX15CM M0035475150","code_information":[{"code":"Px0000373409L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 6MMX10CM M0035476100","code_information":[{"code":"Px0000373410L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 6MMX15CM M0035476150","code_information":[{"code":"Px0000373411L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 7MMX15CM M0035477150","code_information":[{"code":"Px0000373412L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 7MMX20CM M0035477200","code_information":[{"code":"Px0000373413L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 SOFT 8MMX20CM M0035478200","code_information":[{"code":"Px0000373414L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 2MMX3CM M0035422030","code_information":[{"code":"Px0000373422L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 2MMX4CM M0035422040","code_information":[{"code":"Px0000373423L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 2.5MMX4CM M0035422540","code_information":[{"code":"Px0000373424L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 3MMX4CM M0035423040","code_information":[{"code":"Px0000373425L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 3MMX6CM M0035423060","code_information":[{"code":"Px0000373426L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 3MMX8CM M0035423080","code_information":[{"code":"Px0000373427L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 4MMX6CM M0035424060","code_information":[{"code":"Px0000373428L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 4MMX8CM M0035424080","code_information":[{"code":"Px0000373429L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 4MMX10CM M0035424100","code_information":[{"code":"Px0000373430L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 5MMX10CM M0035425100","code_information":[{"code":"Px0000373431L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WIRE NITREX STIFF .035 300CM","code_information":[{"code":"Px0000373456L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 12X40MMX75CM H74939171120470","code_information":[{"code":"Px0000373537L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .014 2.50X120MMX150C A2025120","code_information":[{"code":"Px0000373962L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .014 2.50X200MMX150C A2025200","code_information":[{"code":"Px0000373963L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EXTRACTOR RETREVL 9-12 M00547000","code_information":[{"code":"Px0000373972L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EXTRACT RETRV 12-15 M00547010","code_information":[{"code":"Px0000373973L","type":"CDM"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CEMENT AND MIXER KYPHON XPEDE CX01B","code_information":[{"code":"Px0000374036L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEL SYS CEMENT KYPHON W-SZ 2 CDS2A","code_information":[{"code":"Px0000374037L","type":"CDM"}],"standard_charges":[{"gross_charge":1212.75,"discounted_cash":424.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X80MMX150CM AB14W020080150","code_information":[{"code":"Px0000374269L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ACHIEVE MAPPING 20CM 990063020","code_information":[{"code":"Px0000375565L","type":"CDM"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENPROS VBAHN HEP 5X5X120 VBJ050502","code_information":[{"code":"Px0000375629L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7355.0,"discounted_cash":2574.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENPROS VBAHN HEP 7X5X120 VBJ070502","code_information":[{"code":"Px0000375637L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7175.0,"discounted_cash":2511.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH INFUSION PROWLER PRESHAPE 606171","code_information":[{"code":"Px0000375719L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3619.46,"discounted_cash":1266.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 10ML 9390110","code_information":[{"code":"Px0000375923L","type":"CDM"}],"standard_charges":[{"gross_charge":27.82,"discounted_cash":9.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 20ML 9390120","code_information":[{"code":"Px0000375924L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 30ML 9390130","code_information":[{"code":"Px0000375925L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +8 40ML 9390140","code_information":[{"code":"Px0000375926L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +10 50ML 9390150","code_information":[{"code":"Px0000375927L","type":"CDM"}],"standard_charges":[{"gross_charge":29.2,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC CT SL 4FR 55CM","code_information":[{"code":"Px0000376154L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET THRMB SOLENT OMNI 109681001","code_information":[{"code":"Px0000376223L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7222.5,"discounted_cash":2527.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPPORT CXI ST.035 150CM 4FR","code_information":[{"code":"Px0000376451L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.03,"discounted_cash":267.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPPORT CXI ST .018X150CM 2.6FR G50001","code_information":[{"code":"Px0000376452L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.38,"discounted_cash":293.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPP CXI ANG .018X90CM 2.6FR G50002","code_information":[{"code":"Px0000377650L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.4,"discounted_cash":293.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPPORT CXI ANG.018X150CM 2.6 FR G50003","code_information":[{"code":"Px0000377651L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.4,"discounted_cash":293.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPPORT CXI ANG .035X90CM G52547","code_information":[{"code":"Px0000377652L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.03,"discounted_cash":267.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PREDATOR STEALTH 1.25MM PRDSC30125","code_information":[{"code":"Px0000378289L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":7700.0,"discounted_cash":2695.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH NEURON MAX 6F 90X4CM PNML6F088904","code_information":[{"code":"Px0000378292L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2376.5,"discounted_cash":831.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 5F 25CM W/MKR RSB503","code_information":[{"code":"Px0000378463L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.3,"discounted_cash":36.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 8F 25CM W/MKR RSB803","code_information":[{"code":"Px0000378464L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.3,"discounted_cash":45.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN W/MRKR 9F 25CM RSB903","code_information":[{"code":"Px0000378465L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.3,"discounted_cash":36.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TORCON NB 4F .035X40 KMP G51312","code_information":[{"code":"Px0000378468L","type":"CDM"}],"standard_charges":[{"gross_charge":222.75,"discounted_cash":77.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION 7F 90CM RSC06","code_information":[{"code":"Px0000378479L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4.0X150MMX135CM B2040150","code_information":[{"code":"Px0000378677L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4.0X250MMX135CM B2040250","code_information":[{"code":"Px0000378679L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5.0X150MMX135CM B2050150","code_information":[{"code":"Px0000378680L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5.0X200MMX135CM B2050200","code_information":[{"code":"Px0000378681L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5.0X250MMX135CM B2050250","code_information":[{"code":"Px0000378682L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6.0X150MMX135CM B2060150","code_information":[{"code":"Px0000378683L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6.0X250MMX135CM B2060250","code_information":[{"code":"Px0000378685L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7.0X150MMX135CM B2070150","code_information":[{"code":"Px0000378686L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH GLIDESHEATH 6FR 100MM","code_information":[{"code":"Px0000378723L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.4,"discounted_cash":84.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SKATER BILIARY DRAIN 10FR 755310040","code_information":[{"code":"Px0000378765L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG J 180CM GR3525","code_information":[{"code":"Px0000378782L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.79,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG J 260CM GR3526","code_information":[{"code":"Px0000378783L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.22,"discounted_cash":78.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TISSUE MARKER 8GA MRM4008","code_information":[{"code":"Px0000378827L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.52,"discounted_cash":96.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH HIGH FLEX 6F 55CM G56236","code_information":[{"code":"Px0000378940L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.76,"discounted_cash":98.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X120MMX135CM AB35W05120135","code_information":[{"code":"Px0000378962L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ATRIEVE VAS SNARE KIT 6-10MM","code_information":[{"code":"Px0000380402L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO SWARTZ SL1 63CM 407453","code_information":[{"code":"Px0000380404L","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.25,"discounted_cash":281.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN W/MRKR 5FR 6CM RSB501","code_information":[{"code":"Px0000380584L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.69,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SENSATION IAB 7 FR 40CC 068400047001","code_information":[{"code":"Px0000381037L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":4108.75,"discounted_cash":1438.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL DETACH 360 ULTRA 3MMX10CM M0035423100","code_information":[{"code":"Px0000381357L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL DETACH 360 ULTRA 5MMX15CM M0035425150","code_information":[{"code":"Px0000381359L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL DETACH 360 SOFT 4MMX15CM M0035474150","code_information":[{"code":"Px0000381371L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL DETACH 360 SOFT 5MMX20CM M0035475200","code_information":[{"code":"Px0000381372L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL DETACH 360 SOFT 8MMX30CM M0035478300","code_information":[{"code":"Px0000381375L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FILTER IVC GUNTHER TULIP J F G52918","code_information":[{"code":"Px0000382140L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":4177.06,"discounted_cash":1461.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH 6FR LAUNCHER ERAD LONG TIP","code_information":[{"code":"Px0000382822L","type":"CDM"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":79.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 6X37MMX135CM PXB350637135","code_information":[{"code":"Px0000384073L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 7X37MMX135CM PXB350737135","code_information":[{"code":"Px0000384077L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMO TITAN HD 15.5FRX40","code_information":[{"code":"Px0000384096L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATTRO 62CM 6947M62","code_information":[{"code":"Px0000384597L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO SUPERCROSS 120DEG 5306","code_information":[{"code":"Px0000384646L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2376.5,"discounted_cash":831.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X40MMX80CM B1040040","code_information":[{"code":"Px0000385266L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X20MMX80CM B1050020","code_information":[{"code":"Px0000385271L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X40MMX80CM B1050040","code_information":[{"code":"Px0000385272L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X60MMX80CM B1050060","code_information":[{"code":"Px0000385273L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X80MMX80CM B1050080","code_information":[{"code":"Px0000385274L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X100MMX80CM B1050100","code_information":[{"code":"Px0000385275L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X20MMX80CM B1060020","code_information":[{"code":"Px0000385277L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X40MMX80CM B1060040","code_information":[{"code":"Px0000385278L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X60MMX80CM","code_information":[{"code":"Px0000385279L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X80MMX80CM B1060080","code_information":[{"code":"Px0000385280L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X100MMX80CM B1060100","code_information":[{"code":"Px0000385281L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X20MMX80CM B1070020","code_information":[{"code":"Px0000385283L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X40MMX80CM B1070040","code_information":[{"code":"Px0000385284L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X60MMX80CM","code_information":[{"code":"Px0000385285L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X80MMX80CM B1070080","code_information":[{"code":"Px0000385286L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X20MMX80CM B1080020","code_information":[{"code":"Px0000385289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X40MMX80CM B1080040","code_information":[{"code":"Px0000385290L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X60MMX80CM","code_information":[{"code":"Px0000385291L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X80MMX80CM B1080080","code_information":[{"code":"Px0000385292L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 9X20MMX80CM B1090020","code_information":[{"code":"Px0000385293L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 9X40MMX80CM B1090040","code_information":[{"code":"Px0000385294L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 9X60MMX80CM","code_information":[{"code":"Px0000385295L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X20MMX80CM B1100020","code_information":[{"code":"Px0000385297L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X40MMX80CM B1100040","code_information":[{"code":"Px0000385298L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 12X20MMX80CM B1120020","code_information":[{"code":"Px0000385301L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 12X40MMX80CM B1120040","code_information":[{"code":"Px0000385302L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 14X20MMX80CM","code_information":[{"code":"Px0000385305L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 14X40MMX80CM B1140040","code_information":[{"code":"Px0000385306L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 3X20MMX135CM B2030020","code_information":[{"code":"Px0000385309L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 3X40MMX135CM B2030040","code_information":[{"code":"Px0000385310L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X20MMX135CM B2040020","code_information":[{"code":"Px0000385311L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X40MMX135CM B2040040","code_information":[{"code":"Px0000385312L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X60MMX135CM B2040060","code_information":[{"code":"Px0000385313L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X80MMX135CM B2040080","code_information":[{"code":"Px0000385314L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X100MMX135CM B2040100","code_information":[{"code":"Px0000385315L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 4X120MMX135CM B2040120","code_information":[{"code":"Px0000385316L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X20MMX135CM B2050020","code_information":[{"code":"Px0000385317L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X40MMX135CM B2050040","code_information":[{"code":"Px0000385318L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X80MMX135CM B2050080","code_information":[{"code":"Px0000385320L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 5X100MMX135CM B2050100","code_information":[{"code":"Px0000385321L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X40MMX135CM B2060040","code_information":[{"code":"Px0000385324L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X60MMX135CM B2060060","code_information":[{"code":"Px0000385325L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X100MMX135CM B2060100","code_information":[{"code":"Px0000385327L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 6X120MMX135CM B2060120","code_information":[{"code":"Px0000385328L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X40MMX135CM B2070040","code_information":[{"code":"Px0000385330L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7.0X80MMX135CM B2070080","code_information":[{"code":"Px0000385332L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 7X100MMX135CM B2070100","code_information":[{"code":"Px0000385333L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X20MMX135CM B2080020","code_information":[{"code":"Px0000385335L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8X40MMX135CM B2080040","code_information":[{"code":"Px0000385336L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8.0X60MMX135CM B2080060","code_information":[{"code":"Px0000385337L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 8.0X80MMX135CM B2080080","code_information":[{"code":"Px0000385338L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN ARMDA .035 10X20MMX135CM B2100020","code_information":[{"code":"Px0000385343L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL PACING STS 52CM 2088TC52","code_information":[{"code":"Px0000385358L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL PACING STS 58CM 2088TC58","code_information":[{"code":"Px0000385359L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL TIG 5F 4.5X100CM 405012","code_information":[{"code":"Px0000385582L","type":"CDM"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL TIG 6F 4X100CM 406011","code_information":[{"code":"Px0000385584L","type":"CDM"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL SARAH 6F 4X100CM 406022","code_information":[{"code":"Px0000385587L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X40X80CM","code_information":[{"code":"Px0000385591L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X40X80CM 101252940","code_information":[{"code":"Px0000385597L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X40X80CM 101253040","code_information":[{"code":"Px0000385603L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 9X40X80CM 101253140","code_information":[{"code":"Px0000385609L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 10X40X80C 101253240","code_information":[{"code":"Px0000385615L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X100X135 1012534100","code_information":[{"code":"Px0000385618L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X40X135 101253440","code_information":[{"code":"Px0000385621L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 6X60X135 101253460","code_information":[{"code":"Px0000385622L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X100X135 1012535100","code_information":[{"code":"Px0000385624L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X40X135 101253540","code_information":[{"code":"Px0000385627L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X60X135 101253560","code_information":[{"code":"Px0000385628L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 7X80X135 101253580","code_information":[{"code":"Px0000385629L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X100X135 1012536100","code_information":[{"code":"Px0000385630L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X40X135 101253640","code_information":[{"code":"Px0000385633L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI ABSLT OTW 8X80X135 101253680","code_information":[{"code":"Px0000385635L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X200MMX135CM AB35W04200135","code_information":[{"code":"Px0000386189L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X60MMX80CM AB35W06060080","code_information":[{"code":"Px0000386190L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH HEMODIALYSIS 15.5 FR 55CM","code_information":[{"code":"Px0000386271L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.0,"discounted_cash":381.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CAROTID 40X8/6MMX135CM SECX8640135","code_information":[{"code":"Px0000386425L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 10X37MM X 135 PXB351037135","code_information":[{"code":"Px0000386436L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X100MMX135CM AB35W04100135","code_information":[{"code":"Px0000386475L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X60MMX40CM","code_information":[{"code":"Px0000386484L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X80MMX80CM AB35W06080080","code_information":[{"code":"Px0000386496L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X100MMX80CM AB35W06100080","code_information":[{"code":"Px0000386497L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X150MMX135CM AB35W04150135","code_information":[{"code":"Px0000386524L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X120MMX150CM AB14W020120150","code_information":[{"code":"Px0000386531L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X40MMX150CM AB14W020040150","code_information":[{"code":"Px0000386535L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X40MMX150CM AB14W025040150","code_information":[{"code":"Px0000386539L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X80MMX150CM AB14W025080150","code_information":[{"code":"Px0000386541L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X120MMX150CM AB14W030120150","code_information":[{"code":"Px0000386543L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X40MMX150CM AB14W030040150","code_information":[{"code":"Px0000386547L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X80MMX150CM AB14W030080150","code_information":[{"code":"Px0000386549L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X120MMX150CM AB14W040120150","code_information":[{"code":"Px0000386557L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X40MMX150CM AB14W040040150","code_information":[{"code":"Px0000386561L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PWRXPTA 2.5X100MMX150CM","code_information":[{"code":"Px0000386576L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN PWRXPTA 3.0X150MMX150CM","code_information":[{"code":"Px0000386634L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.5,"discounted_cash":135.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH KIT MICROSNARE 2MM 175CM SK200","code_information":[{"code":"Px0000386671L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2293.2,"discounted_cash":802.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 7122Q 58CM 7122Q58","code_information":[{"code":"Px0000386729L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ICD DURATA SJ4 7120Q 65CM 7122Q65","code_information":[{"code":"Px0000386730L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD VENT QUICKFLEX OPT 86CM 1258T86","code_information":[{"code":"Px0000386733L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.47,"discounted_cash":1649.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REFLEX 5FR .058 8CM 115CM RFX05811508","code_information":[{"code":"Px0000386741L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5989.2,"discounted_cash":2096.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REFLEX 5FR .058 8CM 130CM RFX05813008","code_information":[{"code":"Px0000386743L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5989.2,"discounted_cash":2096.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REFLEX 5FR .072 8CM 115CM","code_information":[{"code":"Px0000386745L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4645.5,"discounted_cash":1625.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MARK MIC 2.8F .027X150X10 FA551501030","code_information":[{"code":"Px0000386747L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4780.2,"discounted_cash":1673.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH NEURON SLCT 5F 120 BER PNS5F120BER","code_information":[{"code":"Px0000387041L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MARKER HYDROMARK 12G 1","code_information":[{"code":"Px0000387492L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.5,"discounted_cash":72.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SKATER BILIARY DRAIN 12FR 755312040","code_information":[{"code":"Px0000387497L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ATRIEVE VAS SNARE KIT 12-20MM","code_information":[{"code":"Px0000388378L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GRAFT STENT CNTRALAT 16X16X124 ETLW1616C124E","code_information":[{"code":"Px0000388904L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":17664.92,"discounted_cash":6182.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GRAFT STENT CNTRALAT 16X16X156 ETLW1616C156E","code_information":[{"code":"Px0000388905L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":22680.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GRAFT STENT CNTRALAT 16X20X124 ETLW1620C124E","code_information":[{"code":"Px0000388909L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ECO LSONAV VAR 22 POLE 7F D134301","code_information":[{"code":"Px0000389716L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":9196.0,"discounted_cash":3218.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS 3MAX 3MAXC 3MAXC","code_information":[{"code":"Px0000389761L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":6394.0,"discounted_cash":2237.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS 4MAX 4MAXC 4MAXC","code_information":[{"code":"Px0000389762L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6693.0,"discounted_cash":2342.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT DRNGE ASPIRA PERI BASIC 4992209","code_information":[{"code":"Px0000389939L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC G-WIRE RUNTHRU EXT NS 259092","code_information":[{"code":"Px0000389948L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RADIAL JACKY 5FR 2SH 405023","code_information":[{"code":"Px0000389950L","type":"CDM"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 6X21MMX80CM 101262229","code_information":[{"code":"Px0000390184L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 6X39MMX80CM 101262239","code_information":[{"code":"Px0000390185L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 7X29MMX80CM 101262329","code_information":[{"code":"Px0000390190L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 7X39MMX80CM 101262339","code_information":[{"code":"Px0000390191L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 8X29MMX80CM 101262429","code_information":[{"code":"Px0000390194L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 8X39MMX80CM 101262439","code_information":[{"code":"Px0000390195L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 8X59X80 101262459","code_information":[{"code":"Px0000390196L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 9X29X80 101262529","code_information":[{"code":"Px0000390198L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 9X39X80 101262539","code_information":[{"code":"Px0000390199L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 10X29MMX80CM 101262629","code_information":[{"code":"Px0000390202L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT OMNI ELT 10X39MMX80CM 101262639","code_information":[{"code":"Px0000390203L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 10X59X80 101262659","code_information":[{"code":"Px0000390204L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 6X29X135 101262929","code_information":[{"code":"Px0000390208L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BLN OMNI ELT 8X29X135 101263129","code_information":[{"code":"Px0000390218L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2058.0,"discounted_cash":720.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CRYOABLT ARTIC ADV 28MM 2AF284","code_information":[{"code":"Px0000390530L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET TUBING COOL POINT 85785","code_information":[{"code":"Px0000390545L","type":"CDM"}],"standard_charges":[{"gross_charge":365.5,"discounted_cash":127.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE AVIGO .014X205CM 1030606200","code_information":[{"code":"Px0000390741L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1717.65,"discounted_cash":601.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH OPTISEAL VALV 7F 1000093002","code_information":[{"code":"Px0000390818L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.25,"discounted_cash":91.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1MMX2CM M0035421020","code_information":[{"code":"Px0000390855L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1MMX3CM M0035421030","code_information":[{"code":"Px0000390856L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1.5MMX2CM M0035421520","code_information":[{"code":"Px0000390857L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1.5MMX3CM M0035421530","code_information":[{"code":"Px0000390858L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULT 1.5MMX4CM M0035421540","code_information":[{"code":"Px0000390859L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PORT CATH CLEARVUE 8FR 1608062","code_information":[{"code":"Px0000391844L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.9,"discounted_cash":653.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN BAKRI POSTPARTUM RAPID G24237 CDM","code_information":[{"code":"Px0000392702L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.45,"discounted_cash":452.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR PUSH 8X1.5MM H7493919008150","code_information":[{"code":"Px0000392828L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 8X3.0MM H7493918908300","code_information":[{"code":"Px0000392834L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 12X1.5MM H7493918912150","code_information":[{"code":"Px0000392842L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 12X2.0MM H7493918912200","code_information":[{"code":"Px0000392843L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 12X2.5MM H7493918912250","code_information":[{"code":"Px0000392845L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 12X3.0MM H7493918912300","code_information":[{"code":"Px0000392847L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 12X4.0MM H7493918912400","code_information":[{"code":"Px0000392851L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR PUSH 15X1.5MM H7493919015150","code_information":[{"code":"Px0000392854L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 15X2.0MM H7493918915200","code_information":[{"code":"Px0000392856L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 15X3.0MM H7493918915300","code_information":[{"code":"Px0000392860L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 15X3.5MM H7493918915350","code_information":[{"code":"Px0000392862L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 15X4.0MM H7493918915400","code_information":[{"code":"Px0000392864L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR PUSH 20X1.2MM H7493919020120","code_information":[{"code":"Px0000392865L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR PUSH 20X1.5MM H7493919020150","code_information":[{"code":"Px0000392867L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 20X2.0MM H7493918920200","code_information":[{"code":"Px0000392869L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 20X2.5MM H7493918920250","code_information":[{"code":"Px0000392871L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN EMERGE MR CATH 20X4.0MM H7493918920400","code_information":[{"code":"Px0000392877L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCEPTER C OCCL 4X10MM BC0410C","code_information":[{"code":"Px0000393080L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5077.8,"discounted_cash":1777.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCEPTER XC OCCL 4X11MM BC0411XC","code_information":[{"code":"Px0000393081L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5865.0,"discounted_cash":2052.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO SUPERCROSS 45DEG","code_information":[{"code":"Px0000393292L","type":"CDM"}],"standard_charges":[{"gross_charge":2376.5,"discounted_cash":831.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH STENT GRFT BLN Q50 PUS","code_information":[{"code":"Px0000393364L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2082.5,"discounted_cash":728.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR 3CG SL 4FR MAX 1194108D","code_information":[{"code":"Px0000393400L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.87,"discounted_cash":373.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR 3CG DL 5FR MAX 1295108D","code_information":[{"code":"Px0000393401L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.06,"discounted_cash":393.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CROSSING VIANCE STD 150CM VNCSD150","code_information":[{"code":"Px0000393691L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7177.5,"discounted_cash":2512.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH RE-ENTRY 135 3.75X20 ENB37520135","code_information":[{"code":"Px0000393693L","type":"CDM"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":9658.0,"discounted_cash":3380.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC ENTEER STD300 .014 ENWSD014300","code_information":[{"code":"Px0000393695L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.5,"discounted_cash":433.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC ENTEER STIF300 .014 ENWSF014300","code_information":[{"code":"Px0000393696L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.5,"discounted_cash":433.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC WHLY HI TORQ 145CM","code_information":[{"code":"Px0000394889L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIM BARE 3D 4MMX12 APB4123DSS","code_information":[{"code":"Px0000394930L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4275.0,"discounted_cash":1496.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIM BARE 3D 5MMX15 APB5153DSS","code_information":[{"code":"Px0000394933L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4275.0,"discounted_cash":1496.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATRO S DF4 55CM 6935M55","code_information":[{"code":"Px0000395023L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD CV SPRINT QUAT S DF4 62CM 6935M62","code_information":[{"code":"Px0000395024L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC HYDRO .035X180CM G56174","code_information":[{"code":"Px0000395992L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.13,"discounted_cash":39.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC FLEXCATH ADV 12FR 4FC12","code_information":[{"code":"Px0000396074L","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN VALVPLSTY NUC-X 22 MMX5CM","code_information":[{"code":"Px0000398318L","type":"CDM"}],"standard_charges":[{"gross_charge":4433.08,"discounted_cash":1551.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVUS PV.035 .038 90CM 88901","code_information":[{"code":"Px0000398385L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":4412.75,"discounted_cash":1544.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN DIL CATH 8FR 16MMX4CMX80CM ATG80164","code_information":[{"code":"Px0000400657L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG OPTRQ TGR4.0 5FR 110 405013","code_information":[{"code":"Px0000400965L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE CPS INNR AIM SL DS2N02265","code_information":[{"code":"Px0000401272L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.2,"discounted_cash":311.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PENUMBRA PXSLIM045 PXSLIM045","code_information":[{"code":"Px0000401518L","type":"CDM"}],"standard_charges":[{"gross_charge":4199.0,"discounted_cash":1469.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DEL MIC PX SLIM .025 STR PXSLIMSTR","code_information":[{"code":"Px0000401519L","type":"CDM"}],"standard_charges":[{"gross_charge":4199.0,"discounted_cash":1469.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC WHSPR EDS CS-J 4648","code_information":[{"code":"Px0000401627L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC RUNTHRU .014X300CM 251013","code_information":[{"code":"Px0000402285L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC FLEXOR HI 6X70 G56221","code_information":[{"code":"Px0000406882L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.17,"discounted_cash":116.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC FLEXOR HI 6X55 G56231","code_information":[{"code":"Px0000406884L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.75,"discounted_cash":98.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE HT COMMAND.014 300CM 2078173","code_information":[{"code":"Px0000409682L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE HT ES COMMAND.014 300CM 2078175","code_information":[{"code":"Px0000409683L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUBING SUCT ASPIR MAX PST2","code_information":[{"code":"Px0000411936L","type":"CDM"}],"standard_charges":[{"gross_charge":1082.0,"discounted_cash":378.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 2.5X10MM 22002510","code_information":[{"code":"Px0000413219L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 3.5X10MM 22003510","code_information":[{"code":"Px0000413221L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 3.0X15MM 22003015","code_information":[{"code":"Px0000413227L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 3.5X15MM 22003515","code_information":[{"code":"Px0000413229L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FILTER VASC OPTION ELITE 30MM 352506070E","code_information":[{"code":"Px0000416206L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS GLDPTH 14.5F 19CM KT 5393190","code_information":[{"code":"Px0000416208L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.25,"discounted_cash":511.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS GLDEPH 14.5F 23CM KT 5393230","code_information":[{"code":"Px0000416209L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.25,"discounted_cash":511.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS GLDEPH 14.5F 27CM KT 5393270","code_information":[{"code":"Px0000416210L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.25,"discounted_cash":511.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LV QUARTET LEAD 1458Q/86 1458Q86","code_information":[{"code":"Px0000417885L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.47,"discounted_cash":1649.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOLITAIRE2 FR REVASC 4X15","code_information":[{"code":"Px0000419023L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOLITAIRE2 FR REVASC 4X20","code_information":[{"code":"Px0000419024L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOLITAIRE2 FR REVASC 6X30","code_information":[{"code":"Px0000419026L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN GUIDE CELLO 8FR 1610580","code_information":[{"code":"Px0000419027L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4631.25,"discounted_cash":1620.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN GUIDE CELLO 9FR","code_information":[{"code":"Px0000419028L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4631.25,"discounted_cash":1620.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 2.0X8MM 101240308A","code_information":[{"code":"Px0000419044L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 2.0X12MM 101240312A","code_information":[{"code":"Px0000419045L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINITREK II OTW 2.0X20MM 101240320A","code_information":[{"code":"Px0000419047L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT IMPELLA PUMP CATH 005062","code_information":[{"code":"Px0000421852L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":103000.0,"discounted_cash":36050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CP IMPELLA 14F 00480003","code_information":[{"code":"Px0000421877L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":103000.0,"discounted_cash":36050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CANISTER ASPIR MAX PAPS2","code_information":[{"code":"Px0000424121L","type":"CDM"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IAB MEGA 7.5FR 40CC","code_information":[{"code":"Px0000424190L","type":"CDM"}],"standard_charges":[{"gross_charge":3710.4,"discounted_cash":1298.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IAB MEGA 7.5FR 30CC","code_information":[{"code":"Px0000424192L","type":"CDM"}],"standard_charges":[{"gross_charge":1875.0,"discounted_cash":656.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS TITAN 15.5FR 28CM","code_information":[{"code":"Px0000424284L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS TITAN 15.5FR 32CM","code_information":[{"code":"Px0000424285L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 8F 13CM SS8","code_information":[{"code":"Px0000424286L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 6F 13CM SS6","code_information":[{"code":"Px0000424287L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 9F 13CM SS9","code_information":[{"code":"Px0000424288L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 7F 13CM SS7","code_information":[{"code":"Px0000424289L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET HEL ULTRA 1MMX1CM M0035431010","code_information":[{"code":"Px0000425054L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.09,"discounted_cash":1646.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FILTER VASC FEM DENALI DL900F DL900F","code_information":[{"code":"Px0000427229L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":7537.5,"discounted_cash":2638.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX20CM RBY2C0420","code_information":[{"code":"Px0000427252L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 5MMX20CM RBY2C0520","code_information":[{"code":"Px0000427253L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 6MMX20CM RBY2C0620","code_information":[{"code":"Px0000427254L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 7MMX25CM RBY2C0725","code_information":[{"code":"Px0000427255L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 8MMX25CM RBY2C0825","code_information":[{"code":"Px0000427256L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 9MMX30CM RBY2C0930","code_information":[{"code":"Px0000427257L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 10MMX35CM RBY2C1035","code_information":[{"code":"Px0000427258L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 12MMX40CM RBY2C1240","code_information":[{"code":"Px0000427259L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 14MMX60CM RBY2C1460","code_information":[{"code":"Px0000427260L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 16MMX60CM RBY2C1660","code_information":[{"code":"Px0000427261L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 18MMX57CM RBY2C1857","code_information":[{"code":"Px0000427262L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 20MMX60CM RBY2C2060","code_information":[{"code":"Px0000427263L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 24MMX57CM RBY2C2457","code_information":[{"code":"Px0000427264L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 28MMX60CM RBY2C2860","code_information":[{"code":"Px0000427265L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 32MMX60CM RBY2C3260","code_information":[{"code":"Px0000427266L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 3MMX15CM RBY4C0315","code_information":[{"code":"Px0000427267L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 4MMX15CM RBY4C0415","code_information":[{"code":"Px0000427268L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 6MMX20CM RBY4C0620","code_information":[{"code":"Px0000427269L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 8MMX35CM RBY4C0835","code_information":[{"code":"Px0000427270L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HANDLE DETACH COIL RBY RH1","code_information":[{"code":"Px0000427272L","type":"CDM"}],"standard_charges":[{"gross_charge":1138.5,"discounted_cash":398.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO NAVICROSS ANG 135CM NC35131","code_information":[{"code":"Px0000427657L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH OPTISEAL VALV 9FR 25 1000093011","code_information":[{"code":"Px0000431407L","type":"CDM"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.5,"discounted_cash":103.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENPROS EXCDR 16MMX13.5CM PLC161400","code_information":[{"code":"Px0000431421L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16422.0,"discounted_cash":5747.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA DR NX GEN CD235740C","code_information":[{"code":"Px0000431609L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":29414.28,"discounted_cash":10295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA DR DF4 NXGEN CD235740Q","code_information":[{"code":"Px0000431610L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":29414.28,"discounted_cash":10295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD-DELLIPSE DR 36 NX GEN CD241136C","code_information":[{"code":"Px0000431611L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":29414.28,"discounted_cash":10295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD-D ELLIPSE DR 36 DF4 NX GEN CD241136Q","code_information":[{"code":"Px0000431612L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":29414.28,"discounted_cash":10295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA VR NX GEN CD135740C","code_information":[{"code":"Px0000431613L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":24382.89,"discounted_cash":8534.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA VR DF4 NXGEN CD135740Q","code_information":[{"code":"Px0000431614L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":24382.89,"discounted_cash":8534.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRT-D QUADRA ASSURA DF4 NX GEN","code_information":[{"code":"Px0000431618L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":25625.0,"discounted_cash":8968.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRT-D UNIFY ASSURA NX GEN CD335740C","code_information":[{"code":"Px0000431619L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":37942.91,"discounted_cash":13280.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRT-D UNIFY ASSURA DF4 NX GEN CD335740Q","code_information":[{"code":"Px0000431620L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":37942.91,"discounted_cash":13280.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE SYNCHRO .014INX35X300CM M00313310","code_information":[{"code":"Px0000431839L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3030.28,"discounted_cash":1060.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE TRANSND .014INX300CM M003468140","code_information":[{"code":"Px0000431840L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2328.48,"discounted_cash":814.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 1.20MMX12MM 101240112Z","code_information":[{"code":"Px0000432032L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL VASC TAR HEL ULT 1.5MMX1C M0035431510","code_information":[{"code":"Px0000432063L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.09,"discounted_cash":1646.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC SAFE2 PEEL 10F 13CM","code_information":[{"code":"Px0000432257L","type":"CDM"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TRUE BAV .035 20X4.5 0204511","code_information":[{"code":"Px0000433978L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO SHEATH SENTRANT 12F 28CM SENSH1228W","code_information":[{"code":"Px0000436079L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO SHEATH SENTRANT 18F 28CM SENSH1828W","code_information":[{"code":"Px0000436082L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOUNDSTAR ECO SMS 10FR","code_information":[{"code":"Px0000437238L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":10788.0,"discounted_cash":3775.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 1.20MMX15MM 101240115Z","code_information":[{"code":"Px0000437273L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS 5 MAX ACE 5MAXACE132","code_information":[{"code":"Px0000437345L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8855.5,"discounted_cash":3099.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH GLIDE SLENDER 6FR 10CM 601060","code_information":[{"code":"Px0000437484L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.75,"discounted_cash":164.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT DRNG ASPIRA PLEUR STRT 4992509","code_information":[{"code":"Px0000437847L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE CHIKAI 200CMX0.014 WAINCKI200","code_information":[{"code":"Px0000438437L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2425.5,"discounted_cash":848.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE CHIKAI 200CMX0.010 WAINCKI10200","code_information":[{"code":"Px0000438439L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.65,"discounted_cash":931.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETRV VASC CLOVERSNARE F6 90CM G53008","code_information":[{"code":"Px0000439032L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2474.32,"discounted_cash":866.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 3MMX5CM RBY2C0305","code_information":[{"code":"Px0000439037L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 3MMX12CM RBY2C0312","code_information":[{"code":"Px0000439038L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 3MMX20CM RBY2C0320","code_information":[{"code":"Px0000439039L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX10CM RBY2C0410","code_information":[{"code":"Px0000439040L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX15CM RBY2C0415","code_information":[{"code":"Px0000439041L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX30CM RBY2C0430","code_information":[{"code":"Px0000439042L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 4MMX35CM RBY2C0435","code_information":[{"code":"Px0000439043L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 5MMX12CM  RBY2C0512","code_information":[{"code":"Px0000439044L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4607.5,"discounted_cash":1612.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 5MMX30CM RBY2C0530","code_information":[{"code":"Px0000439045L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 6MMX30CM RBY2C0630","code_information":[{"code":"Px0000439046L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 8MMX40CM RBY2C0840","code_information":[{"code":"Px0000439047L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX STD 12MMX60CM RBY2C1260","code_information":[{"code":"Px0000439048L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 2MMX1CM RBY4C0201","code_information":[{"code":"Px0000439049L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 2MMX2CM RBY4C0202","code_information":[{"code":"Px0000439050L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 2MMX4CM RBY4C0204","code_information":[{"code":"Px0000439051L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 3MMX5CM RBY4C0305","code_information":[{"code":"Px0000439052L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 4MMX6CM RBY4C0406","code_information":[{"code":"Px0000439053L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 6MMX30CM RBY4C0630","code_information":[{"code":"Px0000439054L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPX SOFT 8MMX60CM RBY4C0860","code_information":[{"code":"Px0000439055L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPXSOFT 16MMX50CM RBY4C1650","code_information":[{"code":"Px0000439056L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL 400 RBY CPXSOFT 20MMX60CM RBY4C2060","code_information":[{"code":"Px0000439057L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD SPRINT QUATRO 65CM 693565","code_information":[{"code":"Px0000439064L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE ASAHI ASTATO XS20 PAGH143392","code_information":[{"code":"Px0000439224L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVUS RADIAL OPTICROSS H749518110","code_information":[{"code":"Px0000440045L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.25,"discounted_cash":1060.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SET THROMBECTOMY SOLENT DISTA 111303001","code_information":[{"code":"Px0000441412L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8566.25,"discounted_cash":2998.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEVICE ORB ATHE MICRO 1.25 145 DBP125MICRO145","code_information":[{"code":"Px0000441652L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":13674.6,"discounted_cash":4786.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BALL COMPLIANT 3X10MM M003SRC03100","code_information":[{"code":"Px0000447365L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":6051.76,"discounted_cash":2118.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BALL COMPLIANT 4 X 10MM M003SRC04100","code_information":[{"code":"Px0000447366L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":6051.76,"discounted_cash":2118.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN SUPR COMPL 3X5MM M003SSC03050","code_information":[{"code":"Px0000447368L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":6051.76,"discounted_cash":2118.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BALL SUPR COMPL 4X10MM M003SSC04100","code_information":[{"code":"Px0000447369L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":6051.76,"discounted_cash":2118.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENV AIGIS R LARGE US IUP CMRM6133","code_information":[{"code":"Px0000448489L","type":"CDM"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4251.25,"discounted_cash":1487.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUBING AND FILTER MAX CANSTR IAPS2","code_information":[{"code":"Px0000448638L","type":"CDM"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACER ASSURITY DR RF","code_information":[{"code":"Px0000449103L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":4900.0,"discounted_cash":1715.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD OPTISURE 210 DF1 65CM LDA21065","code_information":[{"code":"Px0000449114L","type":"CDM"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD OPTISURE DF4 58CM ACT SGL LDA210Q58","code_information":[{"code":"Px0000449116L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD OPTISURE DF4 65CM ACT SGL LDA210Q65","code_information":[{"code":"Px0000449117L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":9325.58,"discounted_cash":3263.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD CAPSURE SENSE 4074 45CM 407445","code_information":[{"code":"Px0000449133L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPP CXI ANG .023X90CM G18372","code_information":[{"code":"Px0000449193L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.05,"discounted_cash":267.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 4.5MMX80MMX120CM 6FR S45080120P6","code_information":[{"code":"Px0000449402L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 4.5MMX60MMX120CM 6FR S45060120P6","code_information":[{"code":"Px0000449403L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5MMX100MMX120CM 6FR S55100120P6","code_information":[{"code":"Px0000449404L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5X150X120C S55150120P6","code_information":[{"code":"Px0000449406L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5MMX40MMX120CM 6FR S55040120P6","code_information":[{"code":"Px0000449683L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 5.5MMX60MMX120CM 6FR S55060120P6","code_information":[{"code":"Px0000449684L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT BILI SUPERA 6.5X80X120 S65080120P6","code_information":[{"code":"Px0000449690L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STNT BILI SUPERA 6.5MMX150MMX120CM 6FR S65150120P6","code_information":[{"code":"Px0000449693L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO VLCITY DLVRY VEL160STR","code_information":[{"code":"Px0000449700L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4859.25,"discounted_cash":1700.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS TITAN 15.5FR 24CM","code_information":[{"code":"Px0000449811L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PICC VASCU SL 3FR","code_information":[{"code":"Px0000449816L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":66.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS GLDPTH 14.5F 42CM KT 5393420","code_information":[{"code":"Px0000452902L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.25,"discounted_cash":511.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SMRT TCH 8F BI FJ CRV D132704","code_information":[{"code":"Px0000453697L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":13687.44,"discounted_cash":4790.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LOOP RECORDER REVEA LNQ11","code_information":[{"code":"Px0000454083L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":18040.5,"discounted_cash":6314.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENV AIGIS R MED US IUP CMRM6122","code_information":[{"code":"Px0000454305L","type":"CDM"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4251.25,"discounted_cash":1487.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC POWERPORT CLEARVUE 8FR 5608062","code_information":[{"code":"Px0000454340L","type":"CDM"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.6,"discounted_cash":395.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYSTEM DETACHMENT INZONE M00345100950","code_information":[{"code":"Px0000454415L","type":"CDM"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 3D 3MMX6CM M0036153060","code_information":[{"code":"Px0000454419L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 3D 4MMX8CM M0036154080","code_information":[{"code":"Px0000454420L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 3D 5MMX10CM M0036155100","code_information":[{"code":"Px0000454421L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 3D 6MMX15CM M0036156150","code_information":[{"code":"Px0000454422L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 3D 7MMX15CM M0036157150","code_information":[{"code":"Px0000454423L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 3D 8MMX25CM M0036158250","code_information":[{"code":"Px0000454424L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6844.96,"discounted_cash":2395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PNTRY NAV ECO CV 7F 262 D D128211","code_information":[{"code":"Px0000454640L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":7627.5,"discounted_cash":2669.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FILTER IVC JUG CELECT PLAT G34309","code_information":[{"code":"Px0000454915L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":4668.6,"discounted_cash":1634.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO HDWY DUO 156CM MC162156S","code_information":[{"code":"Px0000454930L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3124.8,"discounted_cash":1093.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS GLDPTH 14 5F 24CM KT","code_information":[{"code":"Px0000455373L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.09,"discounted_cash":490.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC MARTHN NO STYL 165CM 1055056","code_information":[{"code":"Px0000455439L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":656.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS TL HD 15.5 FX24 SET","code_information":[{"code":"Px0000455465L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":134.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS TL HD 15.5FX32C SET","code_information":[{"code":"Px0000455466L","type":"CDM"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":134.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PNTRY NAV ECO CV 7F 262 F D128208","code_information":[{"code":"Px0000456609L","type":"CDM"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":7627.5,"discounted_cash":2669.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENPROS EXCDR 26X3.3CM PLA260300","code_information":[{"code":"Px0000456806L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11696.0,"discounted_cash":4093.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENPROS EXCDR 28.5X3.3CM PLA280300","code_information":[{"code":"Px0000456807L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11696.0,"discounted_cash":4093.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROPUNCTURE PEDAL ACCESS KIT 5F","code_information":[{"code":"Px0000457702L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.75,"discounted_cash":67.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ATTAIN PERFORMA 429888","code_information":[{"code":"Px0000458188L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.47,"discounted_cash":1649.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 5X5X120CM VBHR050502A","code_information":[{"code":"Px0000458356L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12001.3,"discounted_cash":4200.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 5X15X120CM VBHR051502A","code_information":[{"code":"Px0000458358L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15465.75,"discounted_cash":5413.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 6X5X120CM VBHR060502A","code_information":[{"code":"Px0000458363L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":16621.75,"discounted_cash":5817.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 6X10X120CM VBHR061002A","code_information":[{"code":"Px0000458365L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13541.92,"discounted_cash":4739.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 6X15X120CM","code_information":[{"code":"Px0000458367L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15635.75,"discounted_cash":5472.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 7X5X120CM VBHR070502A","code_information":[{"code":"Px0000458372L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12001.3,"discounted_cash":4200.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 7X10X120CM VBHR071002A","code_information":[{"code":"Px0000458374L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13991.32,"discounted_cash":4896.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 7X15X120CM VBHR071502A","code_information":[{"code":"Px0000458376L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15465.75,"discounted_cash":5413.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 8X5X120CM VBHR080502A","code_information":[{"code":"Px0000458381L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12517.3,"discounted_cash":4381.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 8X10X120CM VBHR081002A","code_information":[{"code":"Px0000458383L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13541.92,"discounted_cash":4739.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 6FR 5X5X120CM VBJR050502A","code_information":[{"code":"Px0000458388L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.48,"discounted_cash":4592.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 6FR 5X10X120CM VBJR051002A","code_information":[{"code":"Px0000458389L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14111.16,"discounted_cash":4938.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 6FR 6X5X120CM VBJR060502A","code_information":[{"code":"Px0000458393L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.48,"discounted_cash":4592.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 6FR 6X10X120CM VBJR061002A","code_information":[{"code":"Px0000458394L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14111.16,"discounted_cash":4938.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 7FR 7X5X120CM VBJR070502A","code_information":[{"code":"Px0000458398L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.48,"discounted_cash":4592.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 7FR 7X10X120CM VBJR071002A","code_information":[{"code":"Px0000458399L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14111.16,"discounted_cash":4938.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 6FR 7X15X120CM VBJR071502A","code_information":[{"code":"Px0000458400L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":16332.75,"discounted_cash":5716.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 7FR 8X5X120CM VBJR080502A","code_information":[{"code":"Px0000458403L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12654.9,"discounted_cash":4429.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A 7FR 8X10X120CM VBJR081002A","code_information":[{"code":"Px0000458404L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14509.2,"discounted_cash":5078.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENPROS EXCDR 14.5X10CM PLC141000","code_information":[{"code":"Px0000458458L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16422.0,"discounted_cash":5747.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENPROS EXCDR 14.5X14CM PLC141400","code_information":[{"code":"Px0000458460L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16422.0,"discounted_cash":5747.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ACUITY X4 STR 86CM 4671","code_information":[{"code":"Px0000458689L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4710.45,"discounted_cash":1648.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ACUITY X4 SH TP SPRL 86 CM 4674","code_information":[{"code":"Px0000458691L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4710.45,"discounted_cash":1648.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ACUITY X4 LG TP SPRL 86CM 4677","code_information":[{"code":"Px0000458693L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4710.45,"discounted_cash":1648.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT DES ALPINE 3.00X18 RX 112530018","code_information":[{"code":"Px0000459245L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2425.0,"discounted_cash":848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO APOLLO 1.5CM 1055095000","code_information":[{"code":"Px0000459317L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7762.5,"discounted_cash":2716.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO APOLLO 3.0CM 1055096000","code_information":[{"code":"Px0000459318L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7762.5,"discounted_cash":2716.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 NANO 2MM X 3CM M0035442030","code_information":[{"code":"Px0000460470L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 NANO 2MM X 4CM M0035442040","code_information":[{"code":"Px0000460471L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 NANO 2.5 X 4CM M0035442540","code_information":[{"code":"Px0000460472L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 NANO 3MM X 4CM M0035443040","code_information":[{"code":"Px0000460473L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 NANO 3MM X 6CM M0035443060","code_information":[{"code":"Px0000460474L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 NANO 3.5 X 6CM M0035443560","code_information":[{"code":"Px0000460475L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET 360 ULTRA 3.5X 8CM M0035423580","code_information":[{"code":"Px0000460486L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.5,"discounted_cash":2551.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN TRANSFORM COMPL 5X15MM M003SRC05150","code_information":[{"code":"Px0000460497L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6051.76,"discounted_cash":2118.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN CATH FLOWGATE BGC 8FR 90CM","code_information":[{"code":"Px0000460505L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.0,"discounted_cash":843.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH EXCELSIOR XT-27 STR 150CM M003XT2750810","code_information":[{"code":"Px0000460604L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3971.0,"discounted_cash":1389.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT TREVO XP PROVUE RETREVER 3X20MM 90183","code_information":[{"code":"Px0000460630L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC TREVO 14 PRO","code_information":[{"code":"Px0000460631L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2539.46,"discounted_cash":888.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE SYNCHRO2 300CM STD M00326510","code_information":[{"code":"Px0000460635L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2774.2,"discounted_cash":970.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE SOFIA 5FR STR 125CM DA5125ST","code_information":[{"code":"Px0000460675L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IAB SENS PLS 8FR 50CC 068400057601U","code_information":[{"code":"Px0000461662L","type":"CDM"}],"standard_charges":[{"gross_charge":4379.5,"discounted_cash":1532.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .018X180CM","code_information":[{"code":"Px0000462937L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .018X300CM GA1830","code_information":[{"code":"Px0000462938L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.0,"discounted_cash":381.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ATTAIN PERFORMA 439888","code_information":[{"code":"Px0000463004L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.47,"discounted_cash":1649.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD ATTAIN PERFORMA 459888","code_information":[{"code":"Px0000463006L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.47,"discounted_cash":1649.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACTA CREAM 10ML CALORIC FORTIFIER","code_information":[{"code":"Px0000463588L","type":"CDM"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":6.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ATRIEVE VAS SNARE KIT 18-30MM 382007030","code_information":[{"code":"Px0000463610L","type":"CDM"}],"standard_charges":[{"gross_charge":1371.15,"discounted_cash":479.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT CATH ATHRECTOMY COR 1.25MMX135CM DBEC125","code_information":[{"code":"Px0000463708L","type":"CDM"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":15066.25,"discounted_cash":5273.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SOLITAIRE2 FR REVASC 4X40 SFR2440","code_information":[{"code":"Px0000463735L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":17488.0,"discounted_cash":6120.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEVICE CLSR VASC MYNXGRIP 5FR MX5021","code_information":[{"code":"Px0000463810L","type":"CDM"}],"standard_charges":[{"gross_charge":1064.25,"discounted_cash":372.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DLYS GLDPTH 14.5F 35CM KT 5393350","code_information":[{"code":"Px0000464350L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.25,"discounted_cash":511.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SHERPA ACTIVE 6F EBU3.0","code_information":[{"code":"Px0000464351L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":79.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X40MMX130CM ADM04004013P","code_information":[{"code":"Px0000465009L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X60MMX130CM ADM04006013P","code_information":[{"code":"Px0000465011L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X80MMX130CM ADM04008013P","code_information":[{"code":"Px0000465013L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X120MMX130CM ADM04012013P","code_information":[{"code":"Px0000465015L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X40MMX130CM ADM05004013P","code_information":[{"code":"Px0000465017L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X60MMX130CM ADM05006013P","code_information":[{"code":"Px0000465019L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X80MMX130CM ADM05008013P","code_information":[{"code":"Px0000465021L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X120MMX130CM ADM05012013P","code_information":[{"code":"Px0000465023L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X40MMX130CM ADM06004013P","code_information":[{"code":"Px0000465025L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X60MMX130CM ADM06006013P","code_information":[{"code":"Px0000465027L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X80MMX130CM ADM06008013P","code_information":[{"code":"Px0000465029L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X120MMX130CM ADM06012013P","code_information":[{"code":"Px0000465031L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X40MMX130CM ADM07004013P","code_information":[{"code":"Px0000465033L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X60MMX130CM ADM07006013P","code_information":[{"code":"Px0000465035L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 7X80MMX130CM ADM07008013P","code_information":[{"code":"Px0000465037L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDECATH SIM2 5FR 65CM CG521","code_information":[{"code":"Px0000465040L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BONE TAMP KIT FF E2 15/2 OI KEX152EB","code_information":[{"code":"Px0000478469L","type":"CDM"}],"standard_charges":[{"gross_charge":11728.04,"discounted_cash":4104.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KYPHON EXP II 20/2 BONE TAMP KIT KEX202EB","code_information":[{"code":"Px0000478471L","type":"CDM"}],"standard_charges":[{"gross_charge":11728.04,"discounted_cash":4104.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXPRESS II 10/2 TRAY WITH CDS KEX102EBCDS","code_information":[{"code":"Px0000478473L","type":"CDM"}],"standard_charges":[{"gross_charge":11728.04,"discounted_cash":4104.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXPRESS II 15/2 TRAY WITH CDS KEX152EBCDS","code_information":[{"code":"Px0000478474L","type":"CDM"}],"standard_charges":[{"gross_charge":11728.04,"discounted_cash":4104.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRT-D DYNAGEN DF4","code_information":[{"code":"Px0000484778L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":28462.0,"discounted_cash":9961.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRT-P VALITUDE X4 QUAD U128","code_information":[{"code":"Px0000484782L","type":"CDM"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":16447.5,"discounted_cash":5756.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE 4FR 150CM ANGLED","code_information":[{"code":"Px0000515889L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.18,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INST RETRV TREVO PROVUE 6X25 90186","code_information":[{"code":"Px0000516114L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11913.0,"discounted_cash":4169.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETVR TRVO PROVUE 6X25PLS XT27 93068","code_information":[{"code":"Px0000516115L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12768.0,"discounted_cash":4468.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 4MM RBYPOD4","code_information":[{"code":"Px0000543983L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7830.0,"discounted_cash":2740.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 5MM RBYPOD5","code_information":[{"code":"Px0000543984L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7830.0,"discounted_cash":2740.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 6MM RBYPOD6","code_information":[{"code":"Px0000543985L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7830.0,"discounted_cash":2740.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY POD 8MM RBYPOD8","code_information":[{"code":"Px0000543986L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7830.0,"discounted_cash":2740.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE CHIKAI 0.26MMX200CM WAINCKI008200","code_information":[{"code":"Px0000544067L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.65,"discounted_cash":931.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE CHIKAI BLK 0.46MM200CM WAINCKI18200BS","code_information":[{"code":"Px0000544068L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2425.5,"discounted_cash":848.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TURNPIKE HARD GOLD 135 CM 5621","code_information":[{"code":"Px0000546483L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3120.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1LS","code_information":[{"code":"Px0000546902L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":13182.4,"discounted_cash":4613.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1LX","code_information":[{"code":"Px0000546903L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":13182.4,"discounted_cash":4613.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT VALVE HEART THV SAPIEN3 23MM 9600CM23A","code_information":[{"code":"Px0000547424L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":133250.0,"discounted_cash":46637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT HRT VLV TAVR SAPIEN 3 26MM 9600CM26A","code_information":[{"code":"Px0000547425L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":133250.0,"discounted_cash":46637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT HRT VLV TAVR SAPIEN 3 29MM 9600CM29A","code_information":[{"code":"Px0000547426L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":133250.0,"discounted_cash":46637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEVICE EMBL PIPLIN FLX 5X35 PED50035","code_information":[{"code":"Px0000547783L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":57266.0,"discounted_cash":20043.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS 5 MAX ACE 64 5MAXACE064","code_information":[{"code":"Px0000574795L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9961.5,"discounted_cash":3486.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT BNCHMK ST 95 W 5F BER 120 BMK6F95BER120","code_information":[{"code":"Px0000574796L","type":"CDM"}],"standard_charges":[{"gross_charge":4536.25,"discounted_cash":1587.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT BNCHMK MP 105 W 5F BER 130 BMK6F105MBER130","code_information":[{"code":"Px0000574799L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4536.25,"discounted_cash":1587.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT HRT VLV TAVR SAPIEN 3 20MM 9600CM20A","code_information":[{"code":"Px0000574954L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":133250.0,"discounted_cash":46637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATHETER 8 XTROQ TIP 115CM CAT8XTORQ115","code_information":[{"code":"Px0000575593L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":12169.0,"discounted_cash":4259.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SEPARATOR WIRE 8 SEP8 SEP8","code_information":[{"code":"Px0000575594L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMADA 6X20X90","code_information":[{"code":"Px0000590720L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMADA 6X40X90 1013460040","code_information":[{"code":"Px0000590721L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 2.0X200X150","code_information":[{"code":"Px0000590737L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 3.0X200X150","code_information":[{"code":"Px0000590755L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 4.0X20X150C","code_information":[{"code":"Px0000590756L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 4.0X80X150C","code_information":[{"code":"Px0000590759L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 5.0X20X150C","code_information":[{"code":"Px0000590765L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 5.0X60X150C 1013468060","code_information":[{"code":"Px0000590767L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 5.0X200X150","code_information":[{"code":"Px0000590773L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 6.0X40X150C 1013470040","code_information":[{"code":"Px0000590784L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 6.0X100X150 1013470100","code_information":[{"code":"Px0000590787L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN OTW ARMDA .018 6.0X150X150","code_information":[{"code":"Px0000590789L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD DR EVERA XT MRI DDMB1D4","code_information":[{"code":"Px0000590989L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":29414.28,"discounted_cash":10295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDESHEATH SLENDER 6FR 601065","code_information":[{"code":"Px0000591044L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.75,"discounted_cash":164.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE SAFARI 2 EX SM CRV 275 H74939406XS1","code_information":[{"code":"Px0000591127L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDESHEATH SLENDER 5FR 601050","code_information":[{"code":"Px0000591377L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.75,"discounted_cash":164.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TURNPIKE SPIRAL 150 CM 5641","code_information":[{"code":"Px0000591645L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3123.4,"discounted_cash":1093.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PINNACLE PRECISION ACCESS 6FR","code_information":[{"code":"Px0000591661L","type":"CDM"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH TRIPLE LUMEN CV 7FRX20CM","code_information":[{"code":"Px0000591662L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":163.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT FLEXHD PLI SM 9X15CM 135SQCM SP0001","code_information":[{"code":"Px0000591720L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.76,"discounted_cash":27.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT FLEXHD PERF LG 13X22CM 286SQCM SF3000","code_information":[{"code":"Px0000591730L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.02,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT FLEXHD PERF XL 15X24CM 360SQCM SF4000","code_information":[{"code":"Px0000591731L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.11,"discounted_cash":25.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC MARKSMAN 160CM FA551601030","code_information":[{"code":"Px0000591894L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4780.2,"discounted_cash":1673.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROCATH REN .018 135CM","code_information":[{"code":"Px0000592779L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2142.67,"discounted_cash":749.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH COBRA 2 5FR 65CM","code_information":[{"code":"Px0000593060L","type":"CDM"}],"standard_charges":[{"gross_charge":48.03,"discounted_cash":16.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLIDESHEATH SLENDER 7FR 601070","code_information":[{"code":"Px0000593081L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.75,"discounted_cash":164.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LOOP RECORDER LINQ SYS LINQSYS","code_information":[{"code":"Px0000593101L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":18040.5,"discounted_cash":6314.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 4X13 45780413","code_information":[{"code":"Px0000593897L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3600.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 6X20 45780620","code_information":[{"code":"Px0000593899L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3600.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 8X28 45780828","code_information":[{"code":"Px0000593901L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3600.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH PRELUDE W/NDL 6 FR PSI6F23018NT4","code_information":[{"code":"Px0000594556L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.78,"discounted_cash":75.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO LANTERN STR 135CM PXSLIMLAN135STR","code_information":[{"code":"Px0000595721L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO LANTERN 45DEG 135CM PXSLIMLAN135T45","code_information":[{"code":"Px0000595722L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO LANTERN 90DEG 135 CM EA PXSLIMLAN135T90","code_information":[{"code":"Px0000595723L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO LANTERN STR 150CM PXSLIMLAN150STR","code_information":[{"code":"Px0000595724L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO LANTERN 45DEG 150CM PXSLIMLAN150T45","code_information":[{"code":"Px0000595725L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO LANTERN 90DEG 150CM PXSLIMLAN150T90","code_information":[{"code":"Px0000595726L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 15 RBYPODJ15","code_information":[{"code":"Px0000595727L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.75,"discounted_cash":1637.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 30 RBYPODJ30","code_information":[{"code":"Px0000595728L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5911.0,"discounted_cash":2068.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 45 RBYPODJ45","code_information":[{"code":"Px0000595729L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5911.0,"discounted_cash":2068.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLDR PERIPHERAL RUBY PODJ 60 RBYPODJ60","code_information":[{"code":"Px0000595730L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5911.0,"discounted_cash":2068.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IMPELLA RP 004334 004334","code_information":[{"code":"Px0000595771L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":103000.0,"discounted_cash":36050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 1.5X2 APB1523DES","code_information":[{"code":"Px0000596046L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 2X3 APB233DES","code_information":[{"code":"Px0000596050L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 2X4 APB243DES","code_information":[{"code":"Px0000596051L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES 3D 3X6 APB363DES","code_information":[{"code":"Px0000596055L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES HX 1.5X4 APB154HXES","code_information":[{"code":"Px0000596066L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5138.25,"discounted_cash":1798.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL AXIUM PRIME ES HX 2X8 APB28HXES","code_information":[{"code":"Px0000596072L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5138.25,"discounted_cash":1798.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENTERPRISE2 4X16 NO TIP ENF401600","code_information":[{"code":"Px0000596699L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":23331.84,"discounted_cash":8166.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT ENTERPRISE2 4X23 NO TIP ENF402300","code_information":[{"code":"Px0000596701L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":23331.84,"discounted_cash":8166.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT TBNG CATH THRMB ACE64 5MAXACE064KIT","code_information":[{"code":"Px0000607468L","type":"CDM"}],"standard_charges":[{"gross_charge":10440.0,"discounted_cash":3654.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DAC AXS CATLYST 5 115CM M003IC0581150","code_information":[{"code":"Px0000607855L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6979.5,"discounted_cash":2442.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DAC AXS CATLYST 5 132CM M003IC0581320","code_information":[{"code":"Px0000607856L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":9306.0,"discounted_cash":3257.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DAC AXS CATLYST 6 132CM M003IC0601320","code_information":[{"code":"Px0000607857L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":9306.0,"discounted_cash":3257.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETRV TREVO XP PROVUE 4X20","code_information":[{"code":"Px0000607858L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FLOWGATE2 BGC 8FR 85CM 90485","code_information":[{"code":"Px0000607859L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4577.1,"discounted_cash":1601.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN FLOWGATE2 BGC 8FR 95CM 90495","code_information":[{"code":"Px0000607860L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4577.1,"discounted_cash":1601.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL TARGET XL 360 SFT 5X15 M0036125150","code_information":[{"code":"Px0000607868L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8755.19,"discounted_cash":3064.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 3.0X12 H7493926012300","code_information":[{"code":"Px0000608795L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 3.0X20 H7493926020300","code_information":[{"code":"Px0000608797L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 3.0X32 H7493926032300","code_information":[{"code":"Px0000608800L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT DES SYNERGY MR 4.0X38 H7493926038400","code_information":[{"code":"Px0000608817L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR10X19 45751019","code_information":[{"code":"Px0000610468L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5077.8,"discounted_cash":1777.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL HYDRO DETACH CX AZUR 5X11 45750511","code_information":[{"code":"Px0000610470L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5077.8,"discounted_cash":1777.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE PRESS COMET 185CM H7495551110","code_information":[{"code":"Px0000610506L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.25,"discounted_cash":1060.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH FUBUKI 6F 90CM STRT KIT WAINFBK6SD","code_information":[{"code":"Px0000610635L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.5,"discounted_cash":433.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT STRAVIX DRSG 3X6CM 18SQCM PS60008","code_information":[{"code":"Px0000610786L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.5,"discounted_cash":248.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG BRNSTN 4FR 125CM","code_information":[{"code":"Px0000610992L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG KA2 4FR 40X25CM","code_information":[{"code":"Px0000610993L","type":"CDM"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG BRNSTN 4FR 65X25CM","code_information":[{"code":"Px0000610994L","type":"CDM"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG KA2 5FR 65X25CM","code_information":[{"code":"Px0000610999L","type":"CDM"}],"standard_charges":[{"gross_charge":59.84,"discounted_cash":20.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT BONE ACC OSTEOCOOL 10G OCN002","code_information":[{"code":"Px0000611240L","type":"CDM"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT PRBE OSTEOCOOL RF17G 10MM OCP210","code_information":[{"code":"Px0000611247L","type":"CDM"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":16128.75,"discounted_cash":5645.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACEMAKER ACCOLADE DR EL MRI L331","code_information":[{"code":"Px0000611409L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":8032.25,"discounted_cash":2811.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACEMAKER ACCOLADE DR MRI L311","code_information":[{"code":"Px0000611410L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":8032.25,"discounted_cash":2811.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACEMAKER ACCOLADE VR MRI L310","code_information":[{"code":"Px0000611411L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":6780.4,"discounted_cash":2373.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD PACER ACTV FIX STR 45 CM 7740","code_information":[{"code":"Px0000611416L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD PACER ACTV FIX STR 52 CM 7741","code_information":[{"code":"Px0000611417L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD PACER ACTV FIX STR 59CM 7742","code_information":[{"code":"Px0000611418L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD VISIA SR AF MRI SURESCAN DVFB1D4","code_information":[{"code":"Px0000611432L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":24382.89,"discounted_cash":8534.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 4X20","code_information":[{"code":"Px0000612095L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 4X40 SFR344010","code_information":[{"code":"Px0000612096L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11913.0,"discounted_cash":4169.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 6X20","code_information":[{"code":"Px0000612097L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REVASC SOLITAIRE 3 6X40 SFR364010","code_information":[{"code":"Px0000612098L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":12540.0,"discounted_cash":4389.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC PHENOM 27 0615 CONFIG FG1515006151S","code_information":[{"code":"Px0000612103L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5031.3,"discounted_cash":1760.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC PHENOM 27 0630 CONFIG","code_information":[{"code":"Px0000612104L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5031.3,"discounted_cash":1760.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PHENOM PLUS 105CM FG1910506301S","code_information":[{"code":"Px0000612105L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6371.0,"discounted_cash":2229.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO PHENOM PLUS 120CM FG1912010301S","code_information":[{"code":"Px0000612106L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6371.0,"discounted_cash":2229.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DIAG ACUNAV 8F 90CM-REP 10135910RH","code_information":[{"code":"Px0000613196L","type":"CDM"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":3956.66,"discounted_cash":1384.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONN CRT-D QUADRA ASSURA 40 DF CD336940Q","code_information":[{"code":"Px0000615015L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":40091.22,"discounted_cash":14031.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD LV QUARTET WD SPC 86CM 1458QL86","code_information":[{"code":"Px0000615020L","type":"CDM"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":4713.47,"discounted_cash":1649.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SV KMP 5F 40 .038 NB PG","code_information":[{"code":"Px0000615436L","type":"CDM"}],"standard_charges":[{"gross_charge":85.85,"discounted_cash":30.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 26 100ML 95026100","code_information":[{"code":"Px0000616189L","type":"CDM"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 28 100ML 95028100","code_information":[{"code":"Px0000616190L","type":"CDM"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH DRYSEAL GORE 12F 45CM DSF1245","code_information":[{"code":"Px0000619929L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.8,"discounted_cash":637.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ADVANCE ASPIR EXPORT","code_information":[{"code":"Px0000620847L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":600.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 4.00X8MM H7493926708400","code_information":[{"code":"Px0000622347L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 5.00X12MM H7493926712500","code_information":[{"code":"Px0000622362L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 5.50X12MM H7493926712550","code_information":[{"code":"Px0000622363L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 2.00X15MM H7493926715200","code_information":[{"code":"Px0000622365L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 5.50X15MM H7493926715550","code_information":[{"code":"Px0000622376L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 6.00X15MM H7493926715600","code_information":[{"code":"Px0000622377L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 3.00X20MM H7493926720300","code_information":[{"code":"Px0000622382L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 4.00X20MM H7493926720400","code_information":[{"code":"Px0000622386L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN NC EMRGE MR CATH 5.00X20MM H7493926720500","code_information":[{"code":"Px0000622388L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE RUNTHRU HYPERCT NS 253011","code_information":[{"code":"Px0000622693L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CV POWER POLY MDL SL 4FR P4154108D","code_information":[{"code":"Px0000623259L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.05,"discounted_cash":225.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICD SUB Q EMB MRI PULSE GEN A219 A219","code_information":[{"code":"Px0000623719L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":68836.05,"discounted_cash":24092.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 12F 33CM DSF1233","code_information":[{"code":"Px0000637127L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.35,"discounted_cash":438.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 18FR 33CM DSF1833","code_information":[{"code":"Px0000637131L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.85,"discounted_cash":594.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 20FR 33CM DSF2033","code_information":[{"code":"Px0000637132L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.85,"discounted_cash":594.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS 5 MAX ACE68 5MAXACE068","code_information":[{"code":"Px0000637726L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":10396.5,"discounted_cash":3638.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT CATH THRMB W/TBNG ACE68 5MAXACE068KIT","code_information":[{"code":"Px0000637727L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":10440.0,"discounted_cash":3654.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPP CXC 4.8-3.7FR 90CM G51580","code_information":[{"code":"Px0000637731L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SUPP CXC 3.4-2.2FR 90CM G51575","code_information":[{"code":"Px0000637732L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":169.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC ASAHI CORSAIR PRO 135CM CSR13526P","code_information":[{"code":"Px0000643004L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2667.5,"discounted_cash":933.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH AXS INFINITY LS 80CM GEN1080080","code_information":[{"code":"Px0000643156L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2022.33,"discounted_cash":707.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AXS INFINITY LS 90CM GEN1080090","code_information":[{"code":"Px0000643157L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2082.5,"discounted_cash":728.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X150MMX130CM ADM04015013P","code_information":[{"code":"Px0000643204L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5750.0,"discounted_cash":2012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X150MMX130CM ADM05015013P","code_information":[{"code":"Px0000643205L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":5750.0,"discounted_cash":2012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1M","code_information":[{"code":"Px0000643290L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":13182.4,"discounted_cash":4613.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PATCH ENSITE PRECIS NAVX SE EN0020P","code_information":[{"code":"Px0000643313L","type":"CDM"}],"standard_charges":[{"gross_charge":4859.25,"discounted_cash":1700.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT VERTBL AUG STABILIT MX LNG","code_information":[{"code":"Px0000643520L","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9787.5,"discounted_cash":3425.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACER ASSURITY MRI DR RF PM2272","code_information":[{"code":"Px0000643575L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":8037.32,"discounted_cash":2813.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 46CM LPA1200M46","code_information":[{"code":"Px0000643579L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 52CM LPA1200M52","code_information":[{"code":"Px0000643580L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 58CM LPA1200M58","code_information":[{"code":"Px0000643581L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":349.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH 5MAX DDC 125CM 5MAXDDC125","code_information":[{"code":"Px0000643703L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE SOFIA 5FR STR 115CM DA5115ST","code_information":[{"code":"Px0000646987L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5869.6,"discounted_cash":2054.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE SOFIA 6FR STR 115CM DA6115ST","code_information":[{"code":"Px0000646988L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8882.2,"discounted_cash":3108.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE SOFIA 6FR STR 125CM DA6125ST","code_information":[{"code":"Px0000646989L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8882.2,"discounted_cash":3108.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO HEADWAY21 2.5F 156C MC212156S","code_information":[{"code":"Px0000646991L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3494.4,"discounted_cash":1223.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH THRMCL SF BI-DIR CRV F-J D134804","code_information":[{"code":"Px0000647108L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":14295.2,"discounted_cash":5003.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH THRMCL SF BI-DIR CRV D-F D134805","code_information":[{"code":"Px0000647109L","type":"CDM"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":14295.2,"discounted_cash":5003.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH GDE EXT GUIDEZILLA II 6F H7493933515060","code_information":[{"code":"Px0000647603L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.5,"discounted_cash":608.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BARD POWER MIDLINE DL 4FR MAX","code_information":[{"code":"Px0000648269L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.5,"discounted_cash":277.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MICRO NINJA 2.9/2.4F 125","code_information":[{"code":"Px0000649359L","type":"CDM"}],"standard_charges":[{"gross_charge":10440.0,"discounted_cash":3654.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN TRUE FLO 18X3.5 11F TF0183511","code_information":[{"code":"Px0000655942L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6670.0,"discounted_cash":2334.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MODEL HIS RT SITE 43CM C315HIS01","code_information":[{"code":"Px0000660213L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.73,"discounted_cash":477.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUMARK VISION 10CM","code_information":[{"code":"Px0000660352L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE CHIKAI BLK SFT TIP 200CM AINCKI200BSFT","code_information":[{"code":"Px0000660391L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH SWAN GANZ CARD CCO 7.5FR 110CM","code_information":[{"code":"Px0000660696L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":262.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC PROGRT 2.0FX130CM MCPC2013Y","code_information":[{"code":"Px0000663546L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2470.0,"discounted_cash":864.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC PROGRT 2.0FX150CM MCPC2015Y","code_information":[{"code":"Px0000663547L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2470.0,"discounted_cash":864.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUMARK PROF X SHP 10CM","code_information":[{"code":"Px0000663883L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.25,"discounted_cash":104.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUMARK PROF Q SHP 10CM 351220","code_information":[{"code":"Px0000663884L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.25,"discounted_cash":104.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LOOP RECORDER CONFIRM RX DM3500","code_information":[{"code":"Px0000664060L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":13804.07,"discounted_cash":4831.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SICD 3501-45CM LEAD 3501","code_information":[{"code":"Px0000664094L","type":"CDM"},{"code":"C1896","type":"HCPCS"}],"standard_charges":[{"gross_charge":11885.2,"discounted_cash":4159.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 5CM SSR0501","code_information":[{"code":"Px0000664459L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 7.5CM SSR7501","code_information":[{"code":"Px0000664460L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 10CM SSR1001","code_information":[{"code":"Px0000664461L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTENNA MWA PERC EMPRINT 15CM CA15L2","code_information":[{"code":"Px0000664532L","type":"CDM"}],"standard_charges":[{"gross_charge":12147.5,"discounted_cash":4251.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTENNA MWA PERC EMPRINT 20CM CA20L2","code_information":[{"code":"Px0000664533L","type":"CDM"}],"standard_charges":[{"gross_charge":12147.5,"discounted_cash":4251.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL POD J SFT 5CM RBYPODJ5 RBYPODJ5","code_information":[{"code":"Px0000666236L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.75,"discounted_cash":1637.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT NEUROFORM ATLAS 4.0X21MM M003SZAS40210","code_information":[{"code":"Px0000668601L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":26796.0,"discounted_cash":9378.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLN SAPPHIRE 2 PRO 1.0MMX15MM 2101535UU","code_information":[{"code":"Px0000672576L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH THROMB LG 140CM CATRXKIT","code_information":[{"code":"Px0000675251L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8321.5,"discounted_cash":2912.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ASPIR REACT 68 REACT68","code_information":[{"code":"Px0000678628L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7650.0,"discounted_cash":2677.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETRV CLOT EMBOTRAP II 5X33MM ET009533","code_information":[{"code":"Px0000679090L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":22785.0,"discounted_cash":7974.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT LOC REF BACK PATCH M004RAPATCH10","code_information":[{"code":"Px0000679304L","type":"CDM"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1052.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL PRIM .020VES 10-12MM RBYPOD12","code_information":[{"code":"Px0000679387L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7830.0,"discounted_cash":2740.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL PRIM .020 VES 3MM EA 1 EA RBYPOD3","code_information":[{"code":"Px0000679389L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7830.0,"discounted_cash":2740.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRAY PICC LUMEN 5FR S1395108D4","code_information":[{"code":"Px0000679421L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.99,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRAY PICC SL 4FR 1194108D4","code_information":[{"code":"Px0000679422L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1208.79,"discounted_cash":423.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH CLOTTRIEVER 16MM 40102","code_information":[{"code":"Px0000679552L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":21000.0,"discounted_cash":7350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CLOTTRIEVER 50101","code_information":[{"code":"Px0000679553L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE ARISTTL SUPP 200CM A14200002","code_information":[{"code":"Px0000680313L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS JET 7 W/TBNG 5MAXJET7KIT","code_information":[{"code":"Px0000680704L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6597.0,"discounted_cash":2308.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO BT 5F 90CMX .038IN G57017","code_information":[{"code":"Px0000681248L","type":"CDM"}],"standard_charges":[{"gross_charge":247.66,"discounted_cash":86.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CANISTER ENGINE PENUMBRA PAPS3","code_information":[{"code":"Px0000684318L","type":"CDM"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRAY CATH PWRGLD FULL 18G 8CM","code_information":[{"code":"Px0000702288L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.45,"discounted_cash":222.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRAY CATH PWRGLD FULL 18G 10CM","code_information":[{"code":"Px0000702289L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.45,"discounted_cash":222.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE HYB STR .012/.014IN HYBRID1214D","code_information":[{"code":"Px0000702865L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":771.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH ASPIR REACT 71 132CM REACT71","code_information":[{"code":"Px0000704831L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7650.0,"discounted_cash":2677.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH LNG BALLAST 088 80CM BALLAST80","code_information":[{"code":"Px0000711231L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH LNG BALLAST 088 90CM BALLAST90","code_information":[{"code":"Px0000711232L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH BLN RX PTCA TAKERU 1.5X15 DCRY1515UA1","code_information":[{"code":"Px0000711244L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEVICE REVASC SOLITAIRE X 6X40 SFR464010","code_information":[{"code":"Px0000711362L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":21945.0,"discounted_cash":7680.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PHENOM 21 160 CM FG1316006151S","code_information":[{"code":"Px0000711368L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5031.3,"discounted_cash":1760.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PHENOM 27 160CM FG1516006151S","code_information":[{"code":"Px0000711369L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5031.3,"discounted_cash":1760.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 15ML 9390115","code_information":[{"code":"Px0000717862L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOCUBE 2.5MM 50MG 1ML .027 EC2550","code_information":[{"code":"Px0000718087L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.6,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOCUBE 5.0MM 50MG 3ML .040 EC5050","code_information":[{"code":"Px0000718090L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.6,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CANSTR ENGINE FOR INDIGO SYSTE IAPS3","code_information":[{"code":"Px0000720439L","type":"CDM"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE 2/14 215CM SUPP S2SPS14215","code_information":[{"code":"Px0000726135L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2371.6,"discounted_cash":830.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE 2/14 300CM SUPP S2SPS14300","code_information":[{"code":"Px0000726137L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2902.24,"discounted_cash":1015.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH DELY ASST AXS OFF 050X150 M003DC050150A0","code_information":[{"code":"Px0000726146L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4308.73,"discounted_cash":1508.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 1MMX2CM RBYLP0102","code_information":[{"code":"Px0000759513L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3792.0,"discounted_cash":1327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 2MMX2CM RBYLP0202","code_information":[{"code":"Px0000759515L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3792.0,"discounted_cash":1327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 2MMX4CM RBYLP0204","code_information":[{"code":"Px0000759516L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3792.0,"discounted_cash":1327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 2MMX10CM RBYLP0210","code_information":[{"code":"Px0000759517L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.75,"discounted_cash":1637.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 3MMX4CM RBYLP0304","code_information":[{"code":"Px0000759518L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3792.0,"discounted_cash":1327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL RUBY LP 3MMX10CM RBYLP0310","code_information":[{"code":"Px0000759519L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.75,"discounted_cash":1637.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL RUBY LP 5MMX10CM RBYLP0510","code_information":[{"code":"Px0000759524L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.75,"discounted_cash":1637.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL PACKING LP 10CM RBYPCLP10","code_information":[{"code":"Px0000759532L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.75,"discounted_cash":1637.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HANDLE DETCHMNT LP SYS RLPH1","code_information":[{"code":"Px0000759537L","type":"CDM"}],"standard_charges":[{"gross_charge":1138.5,"discounted_cash":398.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH CLOTTRIEVER 16FRX15CM 51101","code_information":[{"code":"Px0000761468L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":8800.0,"discounted_cash":3080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH AXS INFINIY LS PLS 70CM INC1119680","code_information":[{"code":"Px0000764893L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2269.93,"discounted_cash":794.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYSTEM GDE BLN CATH .087X90CM BG8087090","code_information":[{"code":"Px0000766445L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7425.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYSTEM GDE BLN CATH .087X95CM EA BG8087095","code_information":[{"code":"Px0000766446L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7425.0,"discounted_cash":2598.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PERF THIN 16X20CM 320SQCM PF1620","code_information":[{"code":"Px0000772272L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.78,"discounted_cash":39.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PERF THICK 12X20CM 240SQCM PF2220","code_information":[{"code":"Px0000772276L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.33,"discounted_cash":39.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PERF THICK 16X20CM 320SQCM PF2620","code_information":[{"code":"Px0000772277L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.78,"discounted_cash":39.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PLIABLE THCK 13X22 286SQCM SF3002","code_information":[{"code":"Px0000772289L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.02,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THIN 17.5X20 350SQCM PP0001","code_information":[{"code":"Px0000772291L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.36,"discounted_cash":45.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THIN 19X22CM 418SQCM PP1500","code_information":[{"code":"Px0000772292L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THIN 21X24CM 504SQCM PP0002","code_information":[{"code":"Px0000772293L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.2,"discounted_cash":39.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THIN 23X26CM 598SQCM PP0003","code_information":[{"code":"Px0000772294L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.86,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THCK 17.5X20 350SQCM PP2001","code_information":[{"code":"Px0000772295L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.36,"discounted_cash":45.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THCK 19X22CM 418SQCM PP1502","code_information":[{"code":"Px0000772296L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THCK 21X24CM 504SQCM PP2002","code_information":[{"code":"Px0000772297L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.2,"discounted_cash":39.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT DERM PRE-THCK 23X26CM 598SQCM PP2003","code_information":[{"code":"Px0000772298L","type":"CDM"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.86,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHEATH VASC FLXSHTH 12FR 65CM DSF1265","code_information":[{"code":"Px0000774867L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.4,"discounted_cash":764.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETRV PROVIEW TREVO NXT 3X32 90312","code_information":[{"code":"Px0000776706L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":22680.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETRV PROVIEW TREVO NXT 4X28 90313","code_information":[{"code":"Px0000776707L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":22680.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETRV PROVIEW TREVO NXT 4X41 90314","code_information":[{"code":"Px0000776708L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":22680.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RETRV PROVIEW TREVO NXT 6X37 90315","code_information":[{"code":"Px0000776709L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":22680.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT DES SYNGY XD MR 4.50X12M H7493941812450","code_information":[{"code":"Px0000776988L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUS JET 7 STD TIP 5MAXJET7BKIT","code_information":[{"code":"Px0000780640L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":10440.0,"discounted_cash":3654.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH MIC TRUSELECT BERN 175CM M001394111750","code_information":[{"code":"Px0000781448L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3758.4,"discounted_cash":1315.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE SYNC SLCT STD PS 215CM SSTD215PRE","code_information":[{"code":"Px0000781624L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2371.6,"discounted_cash":830.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GWIRE SYNC SLCT STD ST 215CM SSTD215STR","code_information":[{"code":"Px0000781625L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.24,"discounted_cash":784.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICCATH SLCTV STR 155CM M001394101550","code_information":[{"code":"Px0000832876L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3549.6,"discounted_cash":1242.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT STRAVIX 3X6CM - 18SQCM PS61036","code_information":[{"code":"Px0000833063L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.5,"discounted_cash":248.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALGRFT STRAVIX 2X4CM 8SQCM PS61024","code_information":[{"code":"Px0000833064L","type":"CDM"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.88,"discounted_cash":336.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT DEEP VEIN ABRE 16MM 100M AB9U16100090","code_information":[{"code":"Px0000833541L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE C2 2.5X12MM C2IVL2512","code_information":[{"code":"Px0000834479L","type":"CDM"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":19834.0,"discounted_cash":6941.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE C2 3.0X12MM C2IVL3012","code_information":[{"code":"Px0000834480L","type":"CDM"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":19834.0,"discounted_cash":6941.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE C2 3.5X12MM C2IVL3512","code_information":[{"code":"Px0000834481L","type":"CDM"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":19834.0,"discounted_cash":6941.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH IVL SHOCKWAVE C2 4.0X12MM C2IVL4012","code_information":[{"code":"Px0000834482L","type":"CDM"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":19834.0,"discounted_cash":6941.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STENT CORO XIENCE SKYP 3.00X12 180430012","code_information":[{"code":"Px0000838951L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":2425.0,"discounted_cash":848.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT FLOWTRIEVER SYSTEM FT-PPP","code_information":[{"code":"Px0000840658L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":41800.0,"discounted_cash":14630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIT CATH REPERFUS RED 62S RED62SKIT","code_information":[{"code":"Px0000842861L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11825.0,"discounted_cash":4138.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH REPERFUSION RED 72 RED72","code_information":[{"code":"Px0000847032L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":10396.5,"discounted_cash":3638.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH INDIGO HTORQ 12MM 115CM LITNG12HTORQ115","code_information":[{"code":"Px0000868388L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":28350.0,"discounted_cash":9922.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SEPARATOR 12 DST F/CAT 150CM SEP12","code_information":[{"code":"Px0000868421L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8321.5,"discounted_cash":2912.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REFLECTOR DELIVERY SYSTEM MARKER SCOUT BX 15GAX12.3CM SSR13B-01","code_information":[{"code":"Px0001012349L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.58,"discounted_cash":499.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 24 100ML 95024100","code_information":[{"code":"Px0001012655L","type":"CDM"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GRAFT BIO SOFT TISS RECTANGLE SURGICLOSE 50205N03D0D 7X10CM 70SQCM","code_information":[{"code":"Px0001079652L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.76,"discounted_cash":91.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GRAFT BIO SOFT TISSUE FISH SURGICLOSE 50205N24D0D 250X250CM 250SQCM","code_information":[{"code":"Px0001087398L","type":"CDM"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.51,"discounted_cash":61.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE","code_information":[{"code":"Px00012010001","type":"CDM"}],"standard_charges":[{"gross_charge":5388.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG W/ TELE","code_information":[{"code":"Px00012010009","type":"CDM"}],"standard_charges":[{"gross_charge":8192.0,"discounted_cash":2867.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B- SEMI-PRIVATE ED BOARDER","code_information":[{"code":"Px00012110005","type":"CDM"}],"standard_charges":[{"gross_charge":5132.0,"discounted_cash":1796.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB","code_information":[{"code":"Px00012210001","type":"CDM"}],"standard_charges":[{"gross_charge":5388.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB HIGH RISK","code_information":[{"code":"Px00012210003","type":"CDM"}],"standard_charges":[{"gross_charge":7802.0,"discounted_cash":2730.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PEDIATRIC","code_information":[{"code":"Px00012310001","type":"CDM"}],"standard_charges":[{"gross_charge":5388.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE DETOX","code_information":[{"code":"Px00012610001","type":"CDM"}],"standard_charges":[{"gross_charge":3363.0,"discounted_cash":1177.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ONCOLOGY","code_information":[{"code":"Px00012710001","type":"CDM"}],"standard_charges":[{"gross_charge":5388.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE REHAB","code_information":[{"code":"Px00012810001","type":"CDM"}],"standard_charges":[{"gross_charge":5635.0,"discounted_cash":1972.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE WARD 3-4 BED 0130","code_information":[{"code":"Px00013010001","type":"CDM"}],"standard_charges":[{"gross_charge":5388.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B- SEMI-PRIVATE MED SURG GYN PACU DC WARD","code_information":[{"code":"Px00013110002","type":"CDM"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS CMS/CA SNF LVL/WA IPF/WA LTAC CDM","code_information":[{"code":"Px00016910001","type":"CDM"}],"standard_charges":[{"gross_charge":5388.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 1","code_information":[{"code":"Px00017110001","type":"CDM"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 2","code_information":[{"code":"Px00017210001","type":"CDM"}],"standard_charges":[{"gross_charge":9193.0,"discounted_cash":3217.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 3","code_information":[{"code":"Px00017310001","type":"CDM"}],"standard_charges":[{"gross_charge":10377.0,"discounted_cash":3631.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 4","code_information":[{"code":"Px00017410001","type":"CDM"}],"standard_charges":[{"gross_charge":11562.0,"discounted_cash":4046.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TCU BED HOLD","code_information":[{"code":"Px00018510004","type":"CDM"}],"standard_charges":[{"gross_charge":4062.0,"discounted_cash":1421.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B SUBACUTE CARE","code_information":[{"code":"Px00019010001","type":"CDM"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B SUBACUTE CARE PRIVATE ROOM","code_information":[{"code":"Px00019010053","type":"CDM"}],"standard_charges":[{"gross_charge":1583.0,"discounted_cash":554.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B SUBACUTE CARE/LEVEL 2","code_information":[{"code":"Px00019200001","type":"CDM"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B SUBACUTE CARE/LEVEL 4","code_information":[{"code":"Px00019410001","type":"CDM"}],"standard_charges":[{"gross_charge":1583.0,"discounted_cash":554.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SUB ACUTE BED - NON VENT","code_information":[{"code":"Px00019910002","type":"CDM"}],"standard_charges":[{"gross_charge":2875.0,"discounted_cash":1006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SUB ACUTE BED - VENT","code_information":[{"code":"Px00019910003","type":"CDM"}],"standard_charges":[{"gross_charge":2893.0,"discounted_cash":1012.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SUB ACUTE BED HOLD - NON VENT","code_information":[{"code":"Px00019910004","type":"CDM"}],"standard_charges":[{"gross_charge":2875.0,"discounted_cash":1006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SUB ACUTE BED HOLD - VENT","code_information":[{"code":"Px00019910005","type":"CDM"}],"standard_charges":[{"gross_charge":2893.0,"discounted_cash":1012.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE 12","code_information":[{"code":"Px00020010003","type":"CDM"}],"standard_charges":[{"gross_charge":10375.0,"discounted_cash":3631.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE 11","code_information":[{"code":"Px00020010004","type":"CDM"}],"standard_charges":[{"gross_charge":13778.0,"discounted_cash":4822.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE 21","code_information":[{"code":"Px00020010005","type":"CDM"}],"standard_charges":[{"gross_charge":18189.0,"discounted_cash":6366.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B INTERMEDIATE LVL 1","code_information":[{"code":"Px00020600001","type":"CDM"}],"standard_charges":[{"gross_charge":8134.0,"discounted_cash":2846.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STEP DOWN 13","code_information":[{"code":"Px00020910002","type":"CDM"}],"standard_charges":[{"gross_charge":9015.0,"discounted_cash":3155.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R&B OB HIGH RISK","code_information":[{"code":"Px00021410004","type":"CDM"}],"standard_charges":[{"gross_charge":7746.0,"discounted_cash":2711.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE CDM","code_information":[{"code":"Px00026010005","type":"CDM"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":166.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00026010007","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":231.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION EACH ADDL HR CDM","code_information":[{"code":"Px00026010008","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":150.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00026010009","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION EA ADDL HR CDM","code_information":[{"code":"Px00026010010","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION SEQUENTIAL DRUG 1ST HR","code_information":[{"code":"Px00026010011","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION CONCURRENT DRUG CDM","code_information":[{"code":"Px00026010012","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT MIDLINE GTE 3 YR CDM","code_information":[{"code":"Px00026010033","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":826.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEWBORN SCREEN SUPPLIES","code_information":[{"code":"Px00027010244","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RF TUMOR ABLATION SYSTEM","code_information":[{"code":"Px00027210330","type":"CDM"}],"standard_charges":[{"gross_charge":10737.5,"discounted_cash":3758.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HFO FLEXION GLOVE","code_information":[{"code":"Px00027410174","type":"CDM"},{"code":"L3912","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHFO  DYNAMIC  CUSTOM","code_information":[{"code":"Px00027410175","type":"CDM"},{"code":"L3900","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EO RIGID  NO JOINTS  PREFAB","code_information":[{"code":"Px00027410176","type":"CDM"},{"code":"L3762","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.5,"discounted_cash":196.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHFO  EXTENSION ASSIST  PREFAB","code_information":[{"code":"Px00027410177","type":"CDM"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHO COCK-UP SPLINT  PREFAB","code_information":[{"code":"Px00027410178","type":"CDM"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HFO  NO JOINTS  PREFAB","code_information":[{"code":"Px00027410179","type":"CDM"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":54.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FO W/JOINTS/SPRING FLEX/EXT PF","code_information":[{"code":"Px00027410180","type":"CDM"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FO NO JOINT/SPRING FLEX/EXT PF","code_information":[{"code":"Px00027410181","type":"CDM"},{"code":"L3927","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EO  NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410236","type":"CDM"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EWHO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410238","type":"CDM"},{"code":"L3764","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EWHFO RIGID NO JOINTS CSTM","code_information":[{"code":"Px00027410239","type":"CDM"},{"code":"L3765","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHFO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410240","type":"CDM"},{"code":"L3806","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHFO RIGID  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410241","type":"CDM"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.5,"discounted_cash":147.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410242","type":"CDM"},{"code":"L3905","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HFO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410243","type":"CDM"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.5,"discounted_cash":147.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HAND ORTHOTIC -  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410244","type":"CDM"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.5,"discounted_cash":74.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HFO W/JOINTS W/BANDS CUSTOM","code_information":[{"code":"Px00027410245","type":"CDM"},{"code":"L3921","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410246","type":"CDM"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FO  W/JOINTS  CUSTOM","code_information":[{"code":"Px00027410247","type":"CDM"},{"code":"L3935","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410269","type":"CDM"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":131.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000003","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000004","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID LAB","code_information":[{"code":"Px00030000006","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":185.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000007","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000008","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000010","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000011","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD DRAW VENIPUNCTURE CDM","code_information":[{"code":"Px00030010004","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - REFERRAL DRAW FEE","code_information":[{"code":"Px00030010005","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM","code_information":[{"code":"Px00030010009","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00030010045","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00030010050","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC ARTERIAL CATHETER LINE SETUP AND INSERTION CDM","code_information":[{"code":"Px00030010051","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1358.0,"discounted_cash":475.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLT3MT MUTATION DETECTION","code_information":[{"code":"Px00030010053","type":"CDM"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH CDM","code_information":[{"code":"Px00030010093","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEWBORN SCN DRAW/HANDLING FEE CDM","code_information":[{"code":"Px00030010147","type":"CDM"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET LAB","code_information":[{"code":"Px00030010191","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030010228","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":139.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET CDM","code_information":[{"code":"Px00030010262","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3698.0,"discounted_cash":1294.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL TRANSLOCATION MAJOR BREAKPOINT LAB","code_information":[{"code":"Px00030010266","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00030010269","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE","code_information":[{"code":"Px00030010271","type":"CDM"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC HNPCC LYNCH SYNDROME GENE ANALYSIS","code_information":[{"code":"Px00030010277","type":"CDM"},{"code":"81301","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS CDM","code_information":[{"code":"Px00030010293","type":"CDM"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","code_information":[{"code":"Px00030010409","type":"CDM"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.36,"discounted_cash":95.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES CDM","code_information":[{"code":"Px00030010410","type":"CDM"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.36,"discounted_cash":95.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM","code_information":[{"code":"Px00030010421","type":"CDM"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":59.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CCP ANTIBODY","code_information":[{"code":"Px00030010438","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - MITOCHONDRIAL","code_information":[{"code":"Px00030010473","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 CDM","code_information":[{"code":"Px00030010492","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 CDM","code_information":[{"code":"Px00030010554","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR CA 19-9","code_information":[{"code":"Px00030010558","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM","code_information":[{"code":"Px00030010560","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS CDM","code_information":[{"code":"Px00030010606","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010660","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUALITATIVE CDM","code_information":[{"code":"Px00030010675","type":"CDM"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ARC CMV SCREEN","code_information":[{"code":"Px00030010752","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.8,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC CMV ANTIBODY","code_information":[{"code":"Px00030010753","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.8,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":55.0,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 CDM","code_information":[{"code":"Px00030010910","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010926","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010931","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030010970","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011006","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":88.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - AB","code_information":[{"code":"Px00030011012","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":88.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE LAB","code_information":[{"code":"Px00030011040","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":349.0,"discounted_cash":122.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ LAB","code_information":[{"code":"Px00030011046","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":24.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":1010.0,"discounted_cash":353.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COOMBS TEST DIRECT - DAT EA ANTISERA","code_information":[{"code":"Px00030011063","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIRECT COOMBS","code_information":[{"code":"Px00030011070","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":8.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":86.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL LAB","code_information":[{"code":"Px00030011076","type":"CDM"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER LAB","code_information":[{"code":"Px00030011079","type":"CDM"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":28.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":240.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":335.0,"discounted_cash":117.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO LAB","code_information":[{"code":"Px00030011083","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":176.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":254.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA - ARC","code_information":[{"code":"Px00030011094","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.14,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA - PER UNIT","code_information":[{"code":"Px00030011095","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.14,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA - REAGENT SERUM","code_information":[{"code":"Px00030011097","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.78,"discounted_cash":13.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011098","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.14,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":654.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011108","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA - SCREEN EA UNIT","code_information":[{"code":"Px00030011110","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.14,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT LAB","code_information":[{"code":"Px00030011111","type":"CDM"},{"code":"86904","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.5,"discounted_cash":21.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS","code_information":[{"code":"Px00030011114","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":654.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN LAB","code_information":[{"code":"Px00030011123","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.8,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":335.0,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ELECTRONIC LAB","code_information":[{"code":"Px00030011125","type":"CDM"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":164.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH LAB","code_information":[{"code":"Px00030011127","type":"CDM"},{"code":"86940","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":26.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC HEMOLYSINS&AGGLUTININS INCUBATED LAB","code_information":[{"code":"Px00030011129","type":"CDM"},{"code":"86941","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.5,"discounted_cash":26.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC VOLUME REDUCTION BLOOD/BLOOD PRODUCT EACH UNIT LAB","code_information":[{"code":"Px00030011131","type":"CDM"},{"code":"86960","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH LAB","code_information":[{"code":"Px00030011132","type":"CDM"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":5.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PRETX SERUM RBC ANTIBODY INCUBATION DRUGS EACH LAB","code_information":[{"code":"Px00030011133","type":"CDM"},{"code":"86975","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.88,"discounted_cash":46.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION LAB","code_information":[{"code":"Px00030011134","type":"CDM"},{"code":"86976","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.76,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA LAB","code_information":[{"code":"Px00030011135","type":"CDM"},{"code":"86977","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC RBC PRETREATMENT SERUM - EACH CELL","code_information":[{"code":"Px00030011136","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN CONCENTRATION","code_information":[{"code":"Px00030011141","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":66.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CULTR BACTERIA EXCEPT BLOOD","code_information":[{"code":"Px00030011159","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","code_information":[{"code":"Px00030011185","type":"CDM"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MACROSCOPIC EXAM PARASITE","code_information":[{"code":"Px00030011197","type":"CDM"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES SMEARS","code_information":[{"code":"Px00030011200","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":401.0,"discounted_cash":140.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAI","code_information":[{"code":"Px00030011226","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":192.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030011248","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":487.0,"discounted_cash":170.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMEAR COMPLEX STAIN-TRICHROME/OVA/PARA","code_information":[{"code":"Px00030011257","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT CDM","code_information":[{"code":"Px00030011259","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMEAR WET MOUNT SALINE/INK - KOH EXAM","code_information":[{"code":"Px00030011260","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":358.0,"discounted_cash":125.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011261","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT CDM","code_information":[{"code":"Px00030011273","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN BY NEUTRALIZATION","code_information":[{"code":"Px00030011401","type":"CDM"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM CDM","code_information":[{"code":"Px00030011405","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.51,"discounted_cash":46.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC BILIRUBIN TOTAL TRANSCUTANEOUS CDM","code_information":[{"code":"Px00030011424","type":"CDM"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":6.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC POOLING PLATELETS/OTHER BLOOD PRODUCTS LAB","code_information":[{"code":"Px00030011514","type":"CDM"},{"code":"86965","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT","code_information":[{"code":"Px00030011519","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":150.0,"discounted_cash":52.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL","code_information":[{"code":"Px00030011520","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL CSF","code_information":[{"code":"Px00030011521","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL SYNOVIAL","code_information":[{"code":"Px00030011522","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011538","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":107.0,"discounted_cash":37.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID CDM","code_information":[{"code":"Px00030011585","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":185.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH CERV/VAG DEFINITIVE HORMONAL EVAL","code_information":[{"code":"Px00030011593","type":"CDM"},{"code":"88155","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011609","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011610","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST LAB","code_information":[{"code":"Px00030011626","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM","code_information":[{"code":"Px00030011646","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IN SITU HYBRIDIZATION SENDOUT","code_information":[{"code":"Px00030011689","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC INFECTIOUS AGENT ANTIGEN DETECTION","code_information":[{"code":"Px00030011692","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO INFLUENZA CDM","code_information":[{"code":"Px00030011697","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC METABOLIC SCRN NEWBORN","code_information":[{"code":"Px00030011718","type":"CDM"},{"code":"S3620","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP A LAB","code_information":[{"code":"Px00030011741","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":290.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":401.0,"discounted_cash":140.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIBODY ELUTION RBC EACH ELUTION LAB","code_information":[{"code":"Px00030011742","type":"CDM"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.5,"discounted_cash":28.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":684.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ROM (AMNISURE)","code_information":[{"code":"Px00030011747","type":"CDM"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RSV ANTIGEN","code_information":[{"code":"Px00030011748","type":"CDM"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":261.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011749","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011759","type":"CDM"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM AG","code_information":[{"code":"Px00030011891","type":"CDM"},{"code":"87272","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":178.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE LAB","code_information":[{"code":"Px00030011963","type":"CDM"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030011966","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.0,"discounted_cash":449.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":796.0,"discounted_cash":278.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CATHETERIZE FOR URINE SPECIMEN P9612","code_information":[{"code":"Px00030011972","type":"CDM"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRG GENE REARG TCELL IN TCELL","code_information":[{"code":"Px00030012012","type":"CDM"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC RBC MORPH","code_information":[{"code":"Px00030012072","type":"CDM"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":58.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":60.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC MOLDX- FLT3 NGS - FLT3 TKD","code_information":[{"code":"Px00030012404","type":"CDM"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC URINE PREGNANCY TEST","code_information":[{"code":"Px00030013001","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE","code_information":[{"code":"Px00030013003","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC OCCULT BLOOD OTHER SOURCES","code_information":[{"code":"Px00030013006","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":45.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":72.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC CDM","code_information":[{"code":"Px00030013008","type":"CDM"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM","code_information":[{"code":"Px00030013009","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030013010","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":35.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030013012","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF C-PEPTIDE","code_information":[{"code":"Px00030013013","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CRYOGLOBULIN","code_information":[{"code":"Px00030013016","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":162.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030013028","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) CDM","code_information":[{"code":"Px00030013086","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL OTHER SOURCE","code_information":[{"code":"Px00030013090","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCIUM SERUM","code_information":[{"code":"Px00030013847","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030013881","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HCG QUANTITATIVE","code_information":[{"code":"Px00030013887","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE CDM","code_information":[{"code":"Px00030013912","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION","code_information":[{"code":"Px00030013944","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME 85610","code_information":[{"code":"Px00030013952","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS CDM","code_information":[{"code":"Px00030013969","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SODIUM","code_information":[{"code":"Px00030013978","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRVVT","code_information":[{"code":"Px00030014048","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.15,"discounted_cash":17.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00030014072","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014113","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ALKALINE PHOS","code_information":[{"code":"Px00030014138","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC AMYLASE URINE","code_information":[{"code":"Px00030014228","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030014447","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030014449","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":349.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BUN","code_information":[{"code":"Px00030014459","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF C-PEPTIDE CDM","code_information":[{"code":"Px00030014462","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","code_information":[{"code":"Px00030014479","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014481","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014482","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030014484","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CARBON DIOXIDE BICARBONATE CDM","code_information":[{"code":"Px00030014495","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CBC WITH DIFF AUTO","code_information":[{"code":"Px00030014514","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":118.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030014520","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":229.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CELIAC IMMUNOASSAY QUANT NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030014523","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"Px00030014542","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CHLORIDE URINE","code_information":[{"code":"Px00030014544","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CK TOTAL","code_information":[{"code":"Px00030014566","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":165.0,"discounted_cash":57.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CK-MB","code_information":[{"code":"Px00030014567","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":197.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COAGULATION TIME ACTIVATED","code_information":[{"code":"Px00030014579","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED","code_information":[{"code":"Px00030014580","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLUMN CHROMOTOGRAPHY QUANT","code_information":[{"code":"Px00030014590","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030014605","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE CLEARANCE-SERUM + URINE","code_information":[{"code":"Px00030014631","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":147.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DDIMER QUANT","code_information":[{"code":"Px00030014674","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030014775","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":452.0,"discounted_cash":158.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00030014776","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ESTRADIOL","code_information":[{"code":"Px00030014796","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FACTOR 8","code_information":[{"code":"Px00030014823","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR IX PTC/CHRISTMAS CDM","code_information":[{"code":"Px00030014833","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":58.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM","code_information":[{"code":"Px00030014877","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN CDM","code_information":[{"code":"Px00030014881","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":334.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS CDM","code_information":[{"code":"Px00030014892","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.18,"discounted_cash":16.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"},{"gross_charge":20.35,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UCLA"}]},{"description":"HC ASSAY OF FOLIC ACID SERUM CDM","code_information":[{"code":"Px00030014898","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM","code_information":[{"code":"Px00030014932","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00030014933","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014937","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GAMMA GT TOTAL","code_information":[{"code":"Px00030014949","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030014950","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE","code_information":[{"code":"Px00030014980","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD","code_information":[{"code":"Px00030014981","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)","code_information":[{"code":"Px00030014986","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C CDM","code_information":[{"code":"Px00030015020","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE","code_information":[{"code":"Px00030015025","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015036","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE CDM","code_information":[{"code":"Px00030015043","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":146.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL CDM","code_information":[{"code":"Px00030015059","type":"CDM"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":136.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEMATOCRIT (HCT)","code_information":[{"code":"Px00030015067","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT SPUN-MISC FLUID","code_information":[{"code":"Px00030015068","type":"CDM"},{"code":"85013","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":52.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEMOGLOBIN (HGB)","code_information":[{"code":"Px00030015080","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030015085","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN CDM","code_information":[{"code":"Px00030015086","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"Px00030015092","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IGE SERUM TOTAL","code_information":[{"code":"Px00030015213","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSULIN LEVEL ASSAY","code_information":[{"code":"Px00030015267","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IRON","code_information":[{"code":"Px00030015298","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IRON BINDING CAPACITY CDM","code_information":[{"code":"Px00030015300","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS CDM","code_information":[{"code":"Px00030015351","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030015357","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LDH SERUM","code_information":[{"code":"Px00030015373","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":205.0,"discounted_cash":71.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL CDM","code_information":[{"code":"Px00030015375","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015391","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIOW CYCLOSPORINE","code_information":[{"code":"Px00030015394","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.75,"discounted_cash":9.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"},{"gross_charge":104.42,"discounted_cash":36.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":26.74,"discounted_cash":9.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UCLA"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES CDM","code_information":[{"code":"Px00030015613","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":45.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":72.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PH GASTRIC CDM","code_information":[{"code":"Px00030015674","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PHOSPHORUS QUANT URINE","code_information":[{"code":"Px00030015691","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLUC BLD GLUC MNTR DEV","code_information":[{"code":"Px00030015715","type":"CDM"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030015718","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM SERUM PLASMA/WHOLE BLOOD","code_information":[{"code":"Px00030015732","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015761","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":227.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":296.0,"discounted_cash":103.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030015763","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":312.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015764","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030015772","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":452.0,"discounted_cash":158.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL URINE PAMC","code_information":[{"code":"Px00030015783","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00030015824","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.6,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC BLOOD COUNT RETICULOCYTE AUTOMATED CDM","code_information":[{"code":"Px00030015882","type":"CDM"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC RETICULATED PLATELET ASSAY CDM","code_information":[{"code":"Px00030015883","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT RETICULOCYTE MANUAL CDM","code_information":[{"code":"Px00030015884","type":"CDM"},{"code":"85044","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SGPT (ALT)","code_information":[{"code":"Px00030015931","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE CDM","code_information":[{"code":"Px00030015963","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.73,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":31.0,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":88.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM","code_information":[{"code":"Px00030015997","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"Px00030016000","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030016020","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROID STIMULATING HORMONE (TSH)","code_information":[{"code":"Px00030016041","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROXINE T4","code_information":[{"code":"Px00030016044","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA CDM","code_information":[{"code":"Px00030016070","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030016086","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030016091","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC UREA QUANT URINE","code_information":[{"code":"Px00030016112","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE LAB","code_information":[{"code":"Px00030016119","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF THIAMINE-VITAMIN B-1 CDM","code_information":[{"code":"Px00030016184","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.67,"discounted_cash":50.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC VITAMIN-B12","code_information":[{"code":"Px00030016196","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":136.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030016244","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE","code_information":[{"code":"Px00030016255","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMICAL TREATMENT RED CELLS","code_information":[{"code":"Px00030016257","type":"CDM"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.74,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC GASES BLOOD PH ONLY CDM","code_information":[{"code":"Px00030016274","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":73.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS CDM","code_information":[{"code":"Px00030016284","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":66.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL CDM","code_information":[{"code":"Px00030016295","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":170.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":207.0,"discounted_cash":72.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC JAK2 (V617F) REFLUX","code_information":[{"code":"Px00030016327","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC LIPID PROFILE","code_information":[{"code":"Px00030017031","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100018","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.74,"discounted_cash":46.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100019","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.73,"discounted_cash":46.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG ASSAY ACETAMINOPHEN LAB","code_information":[{"code":"Px00030100039","type":"CDM"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE -10 11-EPOXIDE LAB","code_information":[{"code":"Px00030100041","type":"CDM"},{"code":"80161","type":"HCPCS"}],"standard_charges":[{"gross_charge":1368.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":468.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG ASSAY SALICYLATE LAB","code_information":[{"code":"Px00030100043","type":"CDM"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALCOHOL (ETHANOL) SPEC XCP UR&BREATH IA LAB","code_information":[{"code":"Px00030100049","type":"CDM"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF DIRECT MEASUREMENT FREE ESTRADIOL LAB","code_information":[{"code":"Px00030100050","type":"CDM"},{"code":"82681","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","code_information":[{"code":"Px00030100119","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100120","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100123","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100124","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100125","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100126","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100133","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100134","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100135","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100136","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100137","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":186.0,"discounted_cash":65.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100138","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100143","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEMAN LAB","code_information":[{"code":"Px00030100202","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100541","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100542","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS LAB","code_information":[{"code":"Px00030100543","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.18,"discounted_cash":16.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"},{"gross_charge":20.35,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UCLA"}]},{"description":"HC DRUG SCREEN QUANTITATIVE VANCOMYCIN LAB","code_information":[{"code":"Px00030100544","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":324.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100550","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100551","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100552","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100562","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100563","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100564","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100566","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100567","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030100568","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100569","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100570","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100571","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT LAB","code_information":[{"code":"Px00030100572","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030100574","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030100575","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100576","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.96,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100579","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100580","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100581","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100582","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100583","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100584","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC CREATINE KINASE TOTAL LAB","code_information":[{"code":"Px00030100585","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":165.0,"discounted_cash":57.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100587","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":197.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100589","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100590","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100591","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100592","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100593","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100594","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100595","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100596","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100603","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100604","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100605","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100609","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100610","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE LAB","code_information":[{"code":"Px00030100616","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF INSULIN TOTAL LAB","code_information":[{"code":"Px00030100622","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE LAB","code_information":[{"code":"Px00030100626","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030100628","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100630","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100631","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030100632","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030100635","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100638","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100639","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100652","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100655","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100656","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100657","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100658","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030100659","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100661","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100662","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100663","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100664","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100665","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100666","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100667","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID LAB","code_information":[{"code":"Px00030100668","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030100761","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100762","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":197.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100763","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":26.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC CORTISOL TOTAL","code_information":[{"code":"Px00030100764","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD LAB","code_information":[{"code":"Px00030100765","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES LAB","code_information":[{"code":"Px00030100771","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100775","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100777","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030100818","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":269.0,"discounted_cash":94.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES LAB","code_information":[{"code":"Px00030100832","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100855","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100856","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100857","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100858","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100859","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100860","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100862","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROCALCITONIN (PCT) LAB","code_information":[{"code":"Px00030100967","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030101044","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101046","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":227.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":296.0,"discounted_cash":103.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF C PEPTIDE LAB","code_information":[{"code":"Px00030101049","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101058","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101059","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101060","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101062","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101063","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030101065","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101073","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101085","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101086","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030101131","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030101132","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030101278","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":494.0,"discounted_cash":172.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN LAB","code_information":[{"code":"Px00030101279","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":494.0,"discounted_cash":172.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030101290","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":104.0,"discounted_cash":36.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030101322","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":66.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":86.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030101324","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":66.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":86.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC LAB","code_information":[{"code":"Px00030101352","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":86.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030101361","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":191.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":362.0,"discounted_cash":126.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030110064","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":227.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":296.0,"discounted_cash":103.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID CDM","code_information":[{"code":"Px00030110077","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3","code_information":[{"code":"Px00030110080","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.18,"discounted_cash":31.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC BLOOD GASES W/O2 SATURATION CDM","code_information":[{"code":"Px00030110103","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":349.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110104","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":190.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CAFFEINE LAB","code_information":[{"code":"Px00030110127","type":"CDM"},{"code":"80155","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG SCREEN QUANT EVEROLIMUS LAB","code_information":[{"code":"Px00030110129","type":"CDM"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UCLA"}]},{"description":"HC DRUGS OF ABUSE URINE","code_information":[{"code":"Px00030110155","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110166","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110167","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110168","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.75,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030110169","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UCLA"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030110170","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.62,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 LAB","code_information":[{"code":"Px00030110171","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.65,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG SCREENING BARBITURATES LAB","code_information":[{"code":"Px00030110172","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.45,"discounted_cash":39.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG SCREENING BARBITURATES LAB","code_information":[{"code":"Px00030110173","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.62,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 LAB","code_information":[{"code":"Px00030110174","type":"CDM"},{"code":"80369","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.62,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 LAB","code_information":[{"code":"Px00030110175","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.64,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","code_information":[{"code":"Px00030110176","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC UNLISTED MOLELCULAR PATHOLOGY PROCEDURE LAB","code_information":[{"code":"Px00030110177","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030110178","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030110179","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030110180","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030110183","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC DRUG SCREEN QUANTITATIVE SIROLIMUS LAB","code_information":[{"code":"Px00030110186","type":"CDM"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - UCLA"}]},{"description":"HC ASSAY OF PARATHORMONE LAB","code_information":[{"code":"Px00030110189","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":398.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030110225","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030110226","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030110228","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030110229","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030110230","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030110444","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":269.0,"discounted_cash":94.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030110479","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110480","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL CDM","code_information":[{"code":"Px00030110510","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.34,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":515.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":119.0,"discounted_cash":41.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030110534","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030110594","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030110595","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030110596","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC MYELIN BASIC PROTEIN CEREBROSPINAL FLUID LAB","code_information":[{"code":"Px00030110597","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC OLIGOCLONAL IMMUNE LAB","code_information":[{"code":"Px00030110598","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"Px00030110602","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":324.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS CDM","code_information":[{"code":"Px00030110635","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2","code_information":[{"code":"Px00030110644","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BLOOD REAGENT STRIP LAB","code_information":[{"code":"Px00030112001","type":"CDM"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":24.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN","code_information":[{"code":"Px00030112003","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC OCCULT BLOOD FECES","code_information":[{"code":"Px00030112004","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"Px00030112005","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CREATINE MB FRACTION","code_information":[{"code":"Px00030112006","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":197.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORESIS OTHER FLUIDS","code_information":[{"code":"Px00030112007","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":452.0,"discounted_cash":158.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN","code_information":[{"code":"Px00030112008","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030112009","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF MAGNESIUM","code_information":[{"code":"Px00030112014","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF BLOOD CHLORIDE","code_information":[{"code":"Px00030112015","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SODIUM BLOOD","code_information":[{"code":"Px00030112016","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROID STIMULATING HORMONE TSH","code_information":[{"code":"Px00030112017","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030112018","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROALBUMIN QUANTITATIVE","code_information":[{"code":"Px00030112020","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030112023","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE","code_information":[{"code":"Px00030112024","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TEST FOR ACETONE/KETONES","code_information":[{"code":"Px00030112025","type":"CDM"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":86.0,"discounted_cash":30.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030112026","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030112027","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF URINE CREATININE","code_information":[{"code":"Px00030112028","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS ACUTE PANEL","code_information":[{"code":"Px00030112029","type":"CDM"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":220.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":243.0,"discounted_cash":85.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"Px00030112031","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":117.0,"discounted_cash":40.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112032","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF FETAL FIBRONECTIN","code_information":[{"code":"Px00030112034","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":334.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PH BODY FLUID NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030112035","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":57.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF CREATININE","code_information":[{"code":"Px00030112042","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"Px00030112043","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":91.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"Px00030112044","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":115.0,"discounted_cash":40.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PREALBUMIN CDM","code_information":[{"code":"Px00030112045","type":"CDM"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL CDM","code_information":[{"code":"Px00030112046","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":299.0,"discounted_cash":104.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF URINE CHLORIDE","code_information":[{"code":"Px00030112047","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL LAB","code_information":[{"code":"Px00030112050","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":260.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC POTASSIUM URINE","code_information":[{"code":"Px00030112055","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030112057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC OSMOLALITY BLOOD","code_information":[{"code":"Px00030112058","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":115.0,"discounted_cash":40.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN TOTAL","code_information":[{"code":"Px00030112059","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":227.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":296.0,"discounted_cash":103.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030112060","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BASIC METABOLIC PANEL","code_information":[{"code":"Px00030112061","type":"CDM"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":184.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":205.0,"discounted_cash":71.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COMPREHEN METABOLIC PANEL","code_information":[{"code":"Px00030112062","type":"CDM"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":254.0,"discounted_cash":88.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"Px00030112063","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC RENAL FUNCTION PANEL CDM","code_information":[{"code":"Px00030112064","type":"CDM"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":207.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":267.0,"discounted_cash":93.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROXINE FREE","code_information":[{"code":"Px00030112065","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST","code_information":[{"code":"Px00030112066","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00030112067","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GTT-ADDED SAMPLES","code_information":[{"code":"Px00030112068","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":49.0,"discounted_cash":17.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"Px00030112069","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE THEOPHYLLINE CDM","code_information":[{"code":"Px00030112071","type":"CDM"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":260.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PHOSPHORUS URINE","code_information":[{"code":"Px00030112072","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00030112073","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY GLUCOSE BLOOD QUANT","code_information":[{"code":"Px00030112099","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00030112100","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":35.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LACTATE (LD) (LDH) ENZYME","code_information":[{"code":"Px00030112101","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":205.0,"discounted_cash":71.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY BLOOD CARBON DIOXIDE","code_information":[{"code":"Px00030112102","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATIC FUNCTION PANEL CDM","code_information":[{"code":"Px00030112103","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":203.0,"discounted_cash":71.05,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ALANINE AMINO (ALT) (SGPT)","code_information":[{"code":"Px00030112104","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF GGT","code_information":[{"code":"Px00030112105","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD FOLIC ACID SERUM","code_information":[{"code":"Px00030112106","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY PHOSPHORUS","code_information":[{"code":"Px00030112107","type":"CDM"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030112108","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":162.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL CDM","code_information":[{"code":"Px00030112109","type":"CDM"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.0,"discounted_cash":286.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":324.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF FERRITIN","code_information":[{"code":"Px00030112111","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112112","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FREE ASSAY (FT-3)","code_information":[{"code":"Px00030112114","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030112115","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LITHIUM CDM","code_information":[{"code":"Px00030112116","type":"CDM"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":198.0,"discounted_cash":69.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IRON BINDING CAPACITY LAB","code_information":[{"code":"Px00030112117","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROXINE TOTAL","code_information":[{"code":"Px00030112118","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB","code_information":[{"code":"Px00030112119","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE LAB","code_information":[{"code":"Px00030112120","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN CDM","code_information":[{"code":"Px00030112121","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN","code_information":[{"code":"Px00030112123","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":229.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF THYROID (T3 OR T4)","code_information":[{"code":"Px00030112125","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CALCULUS SPECTROSCOPY","code_information":[{"code":"Px00030112138","type":"CDM"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.1,"discounted_cash":24.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC HEMOGLOBIN F FETAL QUALITATIVE LAB","code_information":[{"code":"Px00030112154","type":"CDM"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIGLYCERIDES","code_information":[{"code":"Px00030112157","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030112158","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF LIPASE","code_information":[{"code":"Px00030112159","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF CK (CPK)","code_information":[{"code":"Px00030112160","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":165.0,"discounted_cash":57.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PARATHORMONE (PARATHYROID HORMONE)","code_information":[{"code":"Px00030112161","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":398.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT","code_information":[{"code":"Px00030112162","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"Px00030112164","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":324.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC VITAMIN B-12","code_information":[{"code":"Px00030112166","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":136.0,"discounted_cash":47.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030112168","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE CLEARANCE TEST","code_information":[{"code":"Px00030112169","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":147.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SODIUM URINE","code_information":[{"code":"Px00030112172","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL CDM","code_information":[{"code":"Px00030112174","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":199.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":200.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLUCOSE OTHER FLUID","code_information":[{"code":"Px00030112189","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SODIUM OTHER SOURCE LAB","code_information":[{"code":"Px00030112190","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY TRIIODOTHYRONINE (T3)","code_information":[{"code":"Px00030112193","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":226.0,"discounted_cash":79.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY BLD/SERUM CHOLESTEROL","code_information":[{"code":"Px00030112194","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":80.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112195","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG METHOTREXATE LAB","code_information":[{"code":"Px00030112215","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC ASSAY CREATININE","code_information":[{"code":"Px00030112217","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL CDM","code_information":[{"code":"Px00030112228","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":260.0,"discounted_cash":91.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC POTASSIUM","code_information":[{"code":"Px00030112229","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF URINE/UREA-N","code_information":[{"code":"Px00030112231","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE BODY FLUID LAB","code_information":[{"code":"Px00030112238","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030112248","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CHOLESTEROL","code_information":[{"code":"Px00030112251","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":80.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM","code_information":[{"code":"Px00030112278","type":"CDM"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":61.0,"discounted_cash":21.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CARBOXYHEMOGLOBIN","code_information":[{"code":"Px00030112287","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.96,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC METABOLIC PANEL IONIZED CA","code_information":[{"code":"Px00030112290","type":"CDM"},{"code":"80047","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AMYLASE","code_information":[{"code":"Px00030112298","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112310","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TOTAL PROTEIN","code_information":[{"code":"Px00030112314","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PH URINE","code_information":[{"code":"Px00030112332","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE","code_information":[{"code":"Px00030112336","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF AMYLASE FLUID","code_information":[{"code":"Px00030112342","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY AMYLASE URINE","code_information":[{"code":"Px00030112344","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030112351","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030112358","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LDH FLUID","code_information":[{"code":"Px00030112369","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":205.0,"discounted_cash":71.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF OSMOLALITY BLOOD","code_information":[{"code":"Px00030112375","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":115.0,"discounted_cash":40.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SGOT (AST)","code_information":[{"code":"Px00030112384","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":120.0,"discounted_cash":42.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL URINE","code_information":[{"code":"Px00030112394","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN TOTAL CSF","code_information":[{"code":"Px00030112411","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":62.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD CDM","code_information":[{"code":"Px00030112504","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPECIMENS)","code_information":[{"code":"Px00030112505","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLUCOSE TEST 1HR PP LAB","code_information":[{"code":"Px00030112506","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC KAPPA LIGHT CHAIN","code_information":[{"code":"Px00030112517","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.74,"discounted_cash":46.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC URIC ACID BODY FLUID","code_information":[{"code":"Px00030112538","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":90.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC MAGNESIUM-URINE","code_information":[{"code":"Px00030112607","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC TSH","code_information":[{"code":"Px00030112660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CHLORIDE 24 HR URINE LAB","code_information":[{"code":"Px00030112700","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":205.0,"discounted_cash":71.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPEC)","code_information":[{"code":"Px00030112719","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":179.0,"discounted_cash":62.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC LDH BODY FLUID","code_information":[{"code":"Px00030112736","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":205.0,"discounted_cash":71.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF UREA NITROGEN 24 HR URINE LAB","code_information":[{"code":"Px00030112778","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BETA-HYDROXYBUTRIC ACID","code_information":[{"code":"Px00030113017","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE BLD CDM","code_information":[{"code":"Px00030113102","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD W/ DIRECT MEASURE 02 SATURATION CDM","code_information":[{"code":"Px00030113346","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":349.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030113347","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":349.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE URINE LAB","code_information":[{"code":"Px00030113387","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE","code_information":[{"code":"Px00030113411","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":146.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":135.0,"discounted_cash":47.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF IRON CDM","code_information":[{"code":"Px00030113527","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":124.0,"discounted_cash":43.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030113541","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LAMBDA FREE LIGHT CHAINS","code_information":[{"code":"Px00030113548","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.73,"discounted_cash":46.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030113587","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":181.0,"discounted_cash":63.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC POTASSIUM URINE TIMED","code_information":[{"code":"Px00030113777","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN FLUID","code_information":[{"code":"Px00030113820","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":108.0,"discounted_cash":37.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SODIUM SERUM PLASMA OR WHOLE BLOOD CDM","code_information":[{"code":"Px00030114097","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030114183","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":494.0,"discounted_cash":172.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF TRIGLYCERIDES","code_information":[{"code":"Px00030114198","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":146.0,"discounted_cash":51.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE","code_information":[{"code":"Px00030114229","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2 ACETAMINOPHEN","code_information":[{"code":"Px00030114302","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS","code_information":[{"code":"Px00030114380","type":"CDM"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS","code_information":[{"code":"Px00030114381","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS","code_information":[{"code":"Px00030114383","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":96.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES LAB","code_information":[{"code":"Px00030200112","type":"CDM"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.36,"discounted_cash":95.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ANTIBODY MUMPS","code_information":[{"code":"Px00030200118","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200124","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200125","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200126","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200127","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200130","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200132","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200133","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200136","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200152","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200153","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIBODY HIV-2 LAB","code_information":[{"code":"Px00030200250","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.72,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200501","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200502","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200504","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":162.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200505","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":162.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200530","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200537","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200538","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200539","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200543","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200553","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200554","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200562","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030200564","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200668","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.53,"discounted_cash":30.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200669","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.06,"discounted_cash":38.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200670","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.53,"discounted_cash":30.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200671","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.53,"discounted_cash":30.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200676","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200680","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","code_information":[{"code":"Px00030200681","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200682","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200683","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200684","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200685","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200686","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200687","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200688","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY","code_information":[{"code":"Px00030200689","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030201036","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":159.0,"discounted_cash":55.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030201037","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":159.0,"discounted_cash":55.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030201040","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":77.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":159.0,"discounted_cash":55.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030201042","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":159.0,"discounted_cash":55.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030201044","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":159.0,"discounted_cash":55.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030201046","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":159.0,"discounted_cash":55.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030201050","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":159.0,"discounted_cash":55.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030201054","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030201057","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030210068","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030210074","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":312.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC GAMMAGLOBULIN IGM","code_information":[{"code":"Px00030210101","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030210104","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGG","code_information":[{"code":"Px00030210105","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HIV-1 AG W/HIV-1 & HIV-2 AB","code_information":[{"code":"Px00030210183","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030210222","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC ANTIBODY RICKETTSIA LAB","code_information":[{"code":"Px00030210226","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.26,"discounted_cash":21.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC DNA ANTIBODY SINGLE STRANDED LAB","code_information":[{"code":"Px00030210239","type":"CDM"},{"code":"86226","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SARS COV-2 IMMUNE RESPONSE IGG","code_information":[{"code":"Px00030210241","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST QUANTITATIVE LAB","code_information":[{"code":"Px00030210272","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030210273","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA LAB","code_information":[{"code":"Px00030210291","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.27,"discounted_cash":21.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC ANTIBODY HIV-1 LAB","code_information":[{"code":"Px00030210300","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.28,"discounted_cash":29.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC ARC ANTIGEN SCREEN-ANTIGEN","code_information":[{"code":"Px00030210318","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.78,"discounted_cash":13.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ARC PLATELET CROSS MATCH","code_information":[{"code":"Px00030210328","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":189.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ARC RETIC SEPARATION","code_information":[{"code":"Px00030210330","type":"CDM"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.8,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION LAB","code_information":[{"code":"Px00030210331","type":"CDM"},{"code":"86976","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ARC SERUM TREAT W-CHEM-DRUGS","code_information":[{"code":"Px00030210332","type":"CDM"},{"code":"86975","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.5,"discounted_cash":62.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PLATELET ANTIBODIES - HEPARIN","code_information":[{"code":"Px00030210346","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES (ANA) TITER","code_information":[{"code":"Px00030210354","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030210361","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES - ANA","code_information":[{"code":"Px00030210369","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ABSORPTION","code_information":[{"code":"Px00030210372","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.32,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ANTISTREPTOLYSIN O SCREEN LAB","code_information":[{"code":"Px00030210396","type":"CDM"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":80.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC C-REACTIVE PROTEIN","code_information":[{"code":"Px00030210399","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":162.0,"discounted_cash":56.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC MUMPS ANTIBODY IGG","code_information":[{"code":"Px00030210401","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLD AGGLUTININ SCREEN","code_information":[{"code":"Px00030210423","type":"CDM"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC COLD AGGLUTININ TITER CDM","code_information":[{"code":"Px00030210424","type":"CDM"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.6,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":238.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":148.0,"discounted_cash":51.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COMPLEMENT ANTIGEN","code_information":[{"code":"Px00030210459","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED CDM","code_information":[{"code":"Px00030210479","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00030210499","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANT","code_information":[{"code":"Px00030210522","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HERPES SIMPLEX TEST - TYPE 1 IGG","code_information":[{"code":"Px00030210524","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC HETEROPHILE ANTIBODIES","code_information":[{"code":"Px00030210538","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SERUM IMMUNOELECTROPHORESIS","code_information":[{"code":"Px00030210568","type":"CDM"},{"code":"86320","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":271.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OTHER IMMUNOELECTROPHORESIS","code_information":[{"code":"Px00030210569","type":"CDM"},{"code":"86325","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEUKOCYTE PHAGOCYTOSIS LAB","code_information":[{"code":"Px00030210574","type":"CDM"},{"code":"86344","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.6,"discounted_cash":224.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PARTICLE AGGLUTINATION TEST - CRYPTOCOCCUS","code_information":[{"code":"Px00030210577","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANT - RA TITER","code_information":[{"code":"Px00030210591","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":83.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":105.0,"discounted_cash":36.75,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL","code_information":[{"code":"Px00030210605","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HIV-1","code_information":[{"code":"Px00030210715","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE","code_information":[{"code":"Px00030210717","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":208.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC RAPID HIV 1-2","code_information":[{"code":"Px00030210718","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HIV-1/HIV-2 SINGLE ASSAY","code_information":[{"code":"Px00030210719","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB CDM","code_information":[{"code":"Px00030210735","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB CDM","code_information":[{"code":"Px00030210737","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210745","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RUBELLA ANTIBODY","code_information":[{"code":"Px00030210766","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":88.0,"discounted_cash":30.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030210798","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) LAB","code_information":[{"code":"Px00030210856","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"},{"gross_charge":176.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":59.0,"discounted_cash":20.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE LAB","code_information":[{"code":"Px00030210867","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA","code_information":[{"code":"Px00030210878","type":"CDM"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT LAB","code_information":[{"code":"Px00030210880","type":"CDM"},{"code":"86985","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPLIT BLOOD OR PRODUCTS - EA","code_information":[{"code":"Px00030210882","type":"CDM"},{"code":"86985","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PLATELET ANTIBODIES - SEROTONIN RELEASE","code_information":[{"code":"Px00030210921","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC PHYSICIAN BLOOD BANK SERVICE - TRANSFUSION REACTION","code_information":[{"code":"Px00030210923","type":"CDM"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":122.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - CSF","code_information":[{"code":"Px00030210935","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM","code_information":[{"code":"Px00030210943","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":199.0,"discounted_cash":69.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HLA TYPING A/B/C MULTIPLE ANTIGENS LAB","code_information":[{"code":"Px00030210950","type":"CDM"},{"code":"86813","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.3,"discounted_cash":112.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC ARC CELL TREAT-CHEM","code_information":[{"code":"Px00030210957","type":"CDM"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.36,"discounted_cash":24.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211005","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRSA PCR","code_information":[{"code":"Px00030211050","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN ASSAY - IGG","code_information":[{"code":"Px00030211074","type":"CDM"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"Px00030211079","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANTISTREPTOLYSIN O TITER - STREPTOZYME TITER","code_information":[{"code":"Px00030211128","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":80.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY IGG/IGM MULTI STEP PROCESS LAB","code_information":[{"code":"Px00030211173","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RPR QUANTITATIVE","code_information":[{"code":"Px00030211505","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":75.0,"discounted_cash":26.25,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500136","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030500137","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN","code_information":[{"code":"Px00030500138","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500141","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":118.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500142","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":118.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500144","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500145","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500146","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED LAB","code_information":[{"code":"Px00030500147","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500148","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":84.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"Px00030500151","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500154","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500155","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY LAB","code_information":[{"code":"Px00030500156","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":115.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500168","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":96.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500169","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":96.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500214","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":84.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500243","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500244","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500254","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030510005","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":84.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT CDM","code_information":[{"code":"Px00030510022","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"Px00030510023","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"Px00030510024","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLEEDING TIME TEST LAB","code_information":[{"code":"Px00030510025","type":"CDM"},{"code":"85002","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":122.0,"discounted_cash":42.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC MANUAL RETICULOCYTE COUNT","code_information":[{"code":"Px00030510026","type":"CDM"},{"code":"85044","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC RBC SED RATE NONAUTOMATED","code_information":[{"code":"Px00030510027","type":"CDM"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":63.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC AUTOMATED LEUKOCYTE COUNT","code_information":[{"code":"Px00030510028","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":47.0,"discounted_cash":16.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB","code_information":[{"code":"Px00030510029","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":118.0,"discounted_cash":41.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC AUTOMATED PLATELET COUNT","code_information":[{"code":"Px00030510030","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":84.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030510032","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":84.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL","code_information":[{"code":"Px00030510033","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":96.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BL SMEAR W/DIFF WBC COUNT","code_information":[{"code":"Px00030510034","type":"CDM"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":39.0,"discounted_cash":13.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC AUTOMATED RETICULOCYTE COUNT","code_information":[{"code":"Px00030510037","type":"CDM"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":56.0,"discounted_cash":19.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"Px00030510038","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":122.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPUN MICROHEMATOCRIT","code_information":[{"code":"Px00030510041","type":"CDM"},{"code":"85013","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":52.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510042","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.49,"discounted_cash":13.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC AUTOMATED DIFF WBC COUNT","code_information":[{"code":"Px00030510047","type":"CDM"},{"code":"85004","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN CDM","code_information":[{"code":"Px00030510055","type":"CDM"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":164.0,"discounted_cash":57.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PROTHROMBIN TEST","code_information":[{"code":"Px00030510058","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPLETE CBC AUTOMATED","code_information":[{"code":"Px00030510062","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":74.0,"discounted_cash":25.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510063","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":117.0,"discounted_cash":40.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL 50-50","code_information":[{"code":"Px00030510067","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DEGRADATION QUANT","code_information":[{"code":"Px00030510069","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE CDM","code_information":[{"code":"Px00030510071","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY CDM","code_information":[{"code":"Px00030510074","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":115.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC SED RATE AUTOMATED","code_information":[{"code":"Px00030510076","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":63.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":69.0,"discounted_cash":24.15,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"Px00030510082","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":84.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510092","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.3,"discounted_cash":9.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC FIBRINOGEN QUANT","code_information":[{"code":"Px00030510125","type":"CDM"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":117.0,"discounted_cash":40.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY CDM","code_information":[{"code":"Px00030510152","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":115.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510207","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":115.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION EA AGENT","code_information":[{"code":"Px00030510217","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510233","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WBC AUTO","code_information":[{"code":"Px00030510310","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":47.0,"discounted_cash":16.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CORONAVIRUS AG IA LAB","code_information":[{"code":"Px00030600007","type":"CDM"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":156.0,"discounted_cash":54.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC NFCT DS 22TRGT SARS-COV-2 BIOFIRE LAB","code_information":[{"code":"Px00030600009","type":"CDM"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2161.0,"discounted_cash":756.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS LAB","code_information":[{"code":"Px00030600070","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600187","type":"CDM"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600362","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600363","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600364","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600365","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600366","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600369","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600370","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600371","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600372","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":479.0,"discounted_cash":167.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600377","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":192.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600380","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS LAB","code_information":[{"code":"Px00030600382","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS","code_information":[{"code":"Px00030600383","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600403","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600404","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600405","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600431","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600432","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600447","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600470","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":192.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET LAB","code_information":[{"code":"Px00030600515","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":2159.0,"discounted_cash":755.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600734","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600736","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":456.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600751","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT CDM","code_information":[{"code":"Px00030610035","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.43,"discounted_cash":47.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610056","type":"CDM"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS LAB","code_information":[{"code":"Px00030610060","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":178.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610061","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":82.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610062","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":82.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET LAB","code_information":[{"code":"Px00030610063","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.25,"discounted_cash":82.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"}]},{"description":"HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 22 TARGETS BIOFIRE PLA LAB","code_information":[{"code":"Px00030610079","type":"CDM"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":686.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES LAB","code_information":[{"code":"Px00030610084","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.12,"discounted_cash":116.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ CDM","code_information":[{"code":"Px00030610107","type":"CDM"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.97,"discounted_cash":136.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC INFLUENZA A AND B SCREEN","code_information":[{"code":"Px00030610118","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KOH EXAM","code_information":[{"code":"Px00030610122","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":245.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PARASITE ID","code_information":[{"code":"Px00030610134","type":"CDM"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM","code_information":[{"code":"Px00030610140","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.74,"discounted_cash":82.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"}]},{"description":"HC IAAD IA ROTAVIRUS CDM","code_information":[{"code":"Px00030610142","type":"CDM"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STREP GROUP A AG","code_information":[{"code":"Px00030610148","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":401.0,"discounted_cash":140.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM","code_information":[{"code":"Px00030610178","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS LAB","code_information":[{"code":"Px00030610189","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.94,"discounted_cash":44.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610207","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD CULTURE FOR BACTERIA","code_information":[{"code":"Px00030610301","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL CDM","code_information":[{"code":"Px00030610304","type":"CDM"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":479.0,"discounted_cash":167.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA CDM","code_information":[{"code":"Px00030610308","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.0,"discounted_cash":449.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":479.0,"discounted_cash":167.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE BACTERIA OTHER","code_information":[{"code":"Px00030610321","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":800.0,"discounted_cash":280.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610356","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":178.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610359","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL CDM","code_information":[{"code":"Px00030610366","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610387","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE SCREEN ONLY - STREP REFLEX","code_information":[{"code":"Px00030610388","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":114.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - MRSA /MSSA","code_information":[{"code":"Px00030610391","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":285.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610392","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1198.0,"discounted_cash":419.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610401","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - THROAT","code_information":[{"code":"Px00030610403","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CULTURE-ANTIB RESIST ORG","code_information":[{"code":"Px00030610407","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC URINE CULTURE/COLONY COUNT","code_information":[{"code":"Px00030610417","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":479.0,"discounted_cash":167.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL","code_information":[{"code":"Px00030610420","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":201.0,"discounted_cash":70.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FUNGUS ISOLATION CULTURE - YEAST","code_information":[{"code":"Px00030610421","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":477.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC FUNGUS ISOLATION CULTURE","code_information":[{"code":"Px00030610423","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1367.0,"discounted_cash":478.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD CDM","code_information":[{"code":"Px00030610432","type":"CDM"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":540.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST LAB","code_information":[{"code":"Px00030610436","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":314.0,"discounted_cash":109.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST CDM","code_information":[{"code":"Px00030610439","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":314.0,"discounted_cash":109.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","code_information":[{"code":"Px00030610444","type":"CDM"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":170.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIA CULTURE - AFB CULTURE","code_information":[{"code":"Px00030610448","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":283.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":401.0,"discounted_cash":140.35,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030610463","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":114.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PINWORM EXAMINATION CDM","code_information":[{"code":"Px00030610477","type":"CDM"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":225.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610482","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":376.0,"discounted_cash":131.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030610483","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":358.0,"discounted_cash":125.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC MICROBE SUSCEPTIBLE DISK - KIRBY-BAUER","code_information":[{"code":"Px00030610490","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1127.0,"discounted_cash":394.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":290.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","code_information":[{"code":"Px00030610491","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":290.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610504","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1127.0,"discounted_cash":394.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":358.0,"discounted_cash":125.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030610507","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610547","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":358.0,"discounted_cash":125.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ LAB","code_information":[{"code":"Px00030610551","type":"CDM"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":393.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":290.0,"discounted_cash":101.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMEAR GRAM STAIN","code_information":[{"code":"Px00030610563","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":170.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":207.0,"discounted_cash":72.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL","code_information":[{"code":"Px00030610570","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":114.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":207.0,"discounted_cash":72.45,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC TISSUE EXAM FOR FUNGI","code_information":[{"code":"Px00030610575","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":250.0,"discounted_cash":87.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC TISSUE EXAM FOR FUNGI - HAIR/NAIL/SKIN","code_information":[{"code":"Px00030610576","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":274.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":250.0,"discounted_cash":87.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CLOSTRIDIUM AG EIA","code_information":[{"code":"Px00030610581","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM CDM","code_information":[{"code":"Px00030610595","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.49,"discounted_cash":107.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"}]},{"description":"HC CRYPTOCOCCAL ANTIGEN TITER","code_information":[{"code":"Px00030610597","type":"CDM"},{"code":"86406","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRYPTOCOCCAL ANTIGEN SCREEN","code_information":[{"code":"Px00030610602","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.05,"discounted_cash":32.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - QUEST"},{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ","code_information":[{"code":"Px00030610623","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":440.0,"discounted_cash":154.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URINE-ISO-ID","code_information":[{"code":"Px00030610636","type":"CDM"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":167.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":239.0,"discounted_cash":83.65,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC C DIFF EIA","code_information":[{"code":"Px00030610661","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HPYLORI STOOL CDM","code_information":[{"code":"Px00030610663","type":"CDM"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":686.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":633.0,"discounted_cash":221.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB","code_information":[{"code":"Px00030610668","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC C DIFFICILE ANTIGEN","code_information":[{"code":"Px00030610669","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610674","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRYPTOCOCCAL ANTIGEN","code_information":[{"code":"Px00030610681","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":285.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700014","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700015","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":140.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700016","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":140.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700017","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00030710008","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM","code_information":[{"code":"Px00030710009","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":140.0,"discounted_cash":49.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC MICROSCOPIC EXAM OF URINE","code_information":[{"code":"Px00030710010","type":"CDM"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":41.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030710012","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":70.0,"discounted_cash":24.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS LAB","code_information":[{"code":"Px00030710026","type":"CDM"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PREGNANCY TEST-URINE (QUAL)","code_information":[{"code":"Px00030710031","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25 CDM","code_information":[{"code":"Px00030910201","type":"CDM"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":4049.0,"discounted_cash":1417.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC DNA HEA 35 AG 11 BLD GRP LAB","code_information":[{"code":"Px00031000192","type":"CDM"},{"code":"0001U","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.5,"discounted_cash":121.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BONE MARROW INTERPRETATION","code_information":[{"code":"Px00031010027","type":"CDM"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":1176.0,"discounted_cash":411.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA CDM","code_information":[{"code":"Px00031010138","type":"CDM"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":79.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC PATHOGEN TEST FOR PLATELETS","code_information":[{"code":"Px00031010176","type":"CDM"},{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMHCHEM/IMCYTCHM EA ADDL SINGLE ANTB STAIN PX LAB","code_information":[{"code":"Px00031010177","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC IMMUNOHISTO ANTB 1ST STAIN - SENDOUT","code_information":[{"code":"Px00031010178","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":45.0,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC INSITU HYBRIDIZATION EACH ADDL - SENDOUT","code_information":[{"code":"Px00031010180","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","code_information":[{"code":"Px00031010186","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":62.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST LAB","code_information":[{"code":"Px00031010209","type":"CDM"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY LAB","code_information":[{"code":"Px00031010292","type":"CDM"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ LAB","code_information":[{"code":"Px00031010312","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":120.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTO SPIN","code_information":[{"code":"Px00031010314","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH BETHESDA CERV/VAG MANUAL","code_information":[{"code":"Px00031010324","type":"CDM"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V LAB","code_information":[{"code":"Px00031010325","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL LAB","code_information":[{"code":"Px00031010327","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN CDM","code_information":[{"code":"Px00031010329","type":"CDM"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT LAB","code_information":[{"code":"Px00031010330","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP SMRS ANY OTH SRC EXTND STD GT 5 SLIDES","code_information":[{"code":"Px00031010335","type":"CDM"},{"code":"88162","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":136.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH SMEAR OTHER SOURCE PREP/SCREEN","code_information":[{"code":"Px00031010337","type":"CDM"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATION SMEARS & INTERPRETATION TECH LAB","code_information":[{"code":"Px00031010339","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP SMRS ANY OTH SRC SCR&INTERPJ LAB","code_information":[{"code":"Px00031010340","type":"CDM"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DECALCIFICATION PROCEDURE LAB","code_information":[{"code":"Px00031010341","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS LAB","code_information":[{"code":"Px00031010351","type":"CDM"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":479.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":1371.0,"discounted_cash":479.85,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN LAB","code_information":[{"code":"Px00031010379","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.5,"discounted_cash":38.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031010386","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":61.97,"discounted_cash":21.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION 1ST PROBE STAIN LAB","code_information":[{"code":"Px00031010391","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"}]},{"description":"HC PATH CONSLTJ SURG CYTOLOGIC EXAM EACH ADDL SITE LAB","code_information":[{"code":"Px00031010396","type":"CDM"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":40.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE LAB","code_information":[{"code":"Px00031010398","type":"CDM"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":479.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN LAB","code_information":[{"code":"Px00031010406","type":"CDM"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":50.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL LAB","code_information":[{"code":"Px00031010407","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":50.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC MICROSLIDE CONSULTATION W/ SLIDE PREP","code_information":[{"code":"Px00031010429","type":"CDM"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION LAB","code_information":[{"code":"Px00031010468","type":"CDM"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB","code_information":[{"code":"Px00031010473","type":"CDM"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB","code_information":[{"code":"Px00031010498","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":328.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT LAB","code_information":[{"code":"Px00031010500","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":286.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB","code_information":[{"code":"Px00031010519","type":"CDM"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010520","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":94.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010522","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010524","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010531","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010536","type":"CDM"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":479.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","code_information":[{"code":"Px00031010552","type":"CDM"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS LAB","code_information":[{"code":"Px00031010553","type":"CDM"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC TISSUE CULTURE SOLID TUMOR","code_information":[{"code":"Px00031010556","type":"CDM"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL LAB","code_information":[{"code":"Px00031010566","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":92.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST LAB","code_information":[{"code":"Px00031010595","type":"CDM"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":313.0,"discounted_cash":109.55,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE LAB","code_information":[{"code":"Px00031010667","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":61.97,"discounted_cash":21.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - CEDARS"},{"gross_charge":50.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"},{"gross_charge":66.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE LAB","code_information":[{"code":"Px00031010668","type":"CDM"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"}]},{"description":"HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN FISH LAB","code_information":[{"code":"Px00031010669","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - APMG"},{"gross_charge":73.0,"discounted_cash":25.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB","code_information":[{"code":"Px00031010673","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB LAB","code_information":[{"code":"Px00031010674","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC TRB REARRANGEMENT ANAL AMPLIFICATION METHOD LAB","code_information":[{"code":"Px00031010677","type":"CDM"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC M/PHMTRC ALYS ISHQUANT/SEMIQ COMPUTER EA MULTIPLEX LUNG","code_information":[{"code":"Px00031010678","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC M/PHMTRC ALYS ISHQUANT/SEMIQ MANUAL EA MULTIPLEX LUNG","code_information":[{"code":"Px00031010704","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN LAB","code_information":[{"code":"Px00031010718","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN LAB","code_information":[{"code":"Px00031010719","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN LAB","code_information":[{"code":"Px00031010720","type":"CDM"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - PROMETHEUS LAB"}]},{"description":"HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R","code_information":[{"code":"Px00031010776","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT","code_information":[{"code":"Px00031010777","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA LA REGION SENDOUT LAB - NEOGENOMICS"}]},{"description":"HC FLOW CYTOMETRY CELL CYCLE OR DNA ANALYSIS","code_information":[{"code":"Px00031110027","type":"CDM"},{"code":"88182","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":237.0,"discounted_cash":82.95,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN CDM","code_information":[{"code":"Px00031900012","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE OTHER SOURCE (RL)","code_information":[{"code":"Px00031900015","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":127.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"},{"gross_charge":130.0,"discounted_cash":45.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION OUTPATIENT"}]},{"description":"HC BS DXA/OTHER IMG CALCULATION W/I&R FX RISK CDM","code_information":[{"code":"Px00032000006","type":"CDM"},{"code":"77089","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR EYE FOR FOREIGN BODY","code_information":[{"code":"Px00032010003","type":"CDM"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010004","type":"CDM"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE 1-3 VIEWS","code_information":[{"code":"Px00032010006","type":"CDM"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"Px00032010007","type":"CDM"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":371.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MASTOIDS 3/PLUS VIEWS","code_information":[{"code":"Px00032010009","type":"CDM"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES LT/3 VIEWS","code_information":[{"code":"Px00032010011","type":"CDM"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010012","type":"CDM"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.0,"discounted_cash":417.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR NASAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010014","type":"CDM"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ORBITS MIN 4 VIEWS","code_information":[{"code":"Px00032010017","type":"CDM"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SINUSES PARANASAL LT/3 VIEWS","code_information":[{"code":"Px00032010018","type":"CDM"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":187.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SINUSES PARANASAL MIN 3 VIEWS","code_information":[{"code":"Px00032010020","type":"CDM"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":376.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"Px00032010022","type":"CDM"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SKULL MIN 4 VIEWS","code_information":[{"code":"Px00032010023","type":"CDM"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1465.0,"discounted_cash":512.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR JAW JOINT","code_information":[{"code":"Px00032010027","type":"CDM"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR JAW TEMPOROMANDIBULAR JOINT BIL","code_information":[{"code":"Px00032010028","type":"CDM"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":330.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"Px00032010029","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":290.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"Px00032010031","type":"CDM"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":217.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SALIVARY DUCT SIALOGRAPHY","code_information":[{"code":"Px00032010036","type":"CDM"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BONE LENGTH STUDY","code_information":[{"code":"Px00032010039","type":"CDM"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1010.0,"discounted_cash":353.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY LIMITED","code_information":[{"code":"Px00032010040","type":"CDM"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1549.0,"discounted_cash":542.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ESOPHAGUS W CONTRAST","code_information":[{"code":"Px00032010041","type":"CDM"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RIBS UNI 2 VIEWS","code_information":[{"code":"Px00032010045","type":"CDM"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST UNI MIN 3 VIEWS","code_information":[{"code":"Px00032010046","type":"CDM"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RIBS BIL 3 VIEWS","code_information":[{"code":"Px00032010048","type":"CDM"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1136.0,"discounted_cash":397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST BILAT","code_information":[{"code":"Px00032010049","type":"CDM"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM MIN 2 VIEWS","code_information":[{"code":"Px00032010050","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR STERNOCLAVICULAR JOINTS MIN 3 VIEWS","code_information":[{"code":"Px00032010051","type":"CDM"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":229.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE 1 VIEW ANY LEVEL","code_information":[{"code":"Px00032010053","type":"CDM"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":178.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010055","type":"CDM"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":269.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"Px00032010056","type":"CDM"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CERVICAL SPINE 6 OR MORE VIEWS","code_information":[{"code":"Px00032010057","type":"CDM"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.0,"discounted_cash":562.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"Px00032010059","type":"CDM"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":340.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"Px00032010060","type":"CDM"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":340.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC MIN 4 VIEWS","code_information":[{"code":"Px00032010061","type":"CDM"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":346.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACOLUMBAR MIN 2 VIEWS","code_information":[{"code":"Px00032010062","type":"CDM"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":380.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010065","type":"CDM"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPINE LUMBOSACRAL MIN 4 VIEWS","code_information":[{"code":"Px00032010066","type":"CDM"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1694.0,"discounted_cash":592.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL INC BENDING MIN 6 VIEWS","code_information":[{"code":"Px00032010067","type":"CDM"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":1694.0,"discounted_cash":592.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS 1-2 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010069","type":"CDM"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS MIN 3 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010072","type":"CDM"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 1-2 VIEWS","code_information":[{"code":"Px00032010073","type":"CDM"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":159.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 3/PLUS VIEWS","code_information":[{"code":"Px00032010074","type":"CDM"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR TAILBONE MIN 2 VIEWS","code_information":[{"code":"Px00032010075","type":"CDM"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":358.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY CERVICAL","code_information":[{"code":"Px00032010076","type":"CDM"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1714.0,"discounted_cash":599.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY THORACIC","code_information":[{"code":"Px00032010077","type":"CDM"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1714.0,"discounted_cash":599.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY LUMBAR","code_information":[{"code":"Px00032010078","type":"CDM"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":743.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY SPINE 2/PLUS REGIONS","code_information":[{"code":"Px00032010079","type":"CDM"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2946.0,"discounted_cash":1031.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR DISKOGRAPHY LUMBAR","code_information":[{"code":"Px00032010083","type":"CDM"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":5750.0,"discounted_cash":2012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CLAVICLE  COMPLETE","code_information":[{"code":"Px00032010085","type":"CDM"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":178.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW LIMITED","code_information":[{"code":"Px00032010086","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HEEL MIN 2 VIEWS","code_information":[{"code":"Px00032010088","type":"CDM"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":171.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"Px00032010089","type":"CDM"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"Px00032010091","type":"CDM"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER 1 VIEW","code_information":[{"code":"Px00032010092","type":"CDM"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER ARTHROGRAPHY","code_information":[{"code":"Px00032010097","type":"CDM"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3104.0,"discounted_cash":1086.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CONTRAST ANKLE","code_information":[{"code":"Px00032010098","type":"CDM"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1837.0,"discounted_cash":642.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER A-C JOINTS BIL","code_information":[{"code":"Px00032010099","type":"CDM"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS 1 VIEW","code_information":[{"code":"Px00032010101","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"Px00032010102","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"Px00032010105","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010106","type":"CDM"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":269.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"Px00032010107","type":"CDM"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"Px00032010110","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ARTHROGRAM OF ELBOW","code_information":[{"code":"Px00032010111","type":"CDM"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.0,"discounted_cash":704.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"Px00032010112","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ARM INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010115","type":"CDM"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":171.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 1 VIEW","code_information":[{"code":"Px00032010117","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"Px00032010118","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR WRIST COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010119","type":"CDM"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00032010122","type":"CDM"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":1060.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HAND 1 VIEW","code_information":[{"code":"Px00032010125","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"Px00032010127","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HAND MIN 3 VIEWS","code_information":[{"code":"Px00032010129","type":"CDM"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FINGERS(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010131","type":"CDM"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 3/PLUS VIEWS","code_information":[{"code":"Px00032010135","type":"CDM"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":319.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HIP ARTHROGRAPHY","code_information":[{"code":"Px00032010140","type":"CDM"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.0,"discounted_cash":358.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 1-2 VIEWS","code_information":[{"code":"Px00032010149","type":"CDM"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"Px00032010152","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":269.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 4/PLUS VIEWS","code_information":[{"code":"Px00032010154","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR KNEES STANDING BILAT","code_information":[{"code":"Px00032010156","type":"CDM"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":205.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR KNEE JOINT W CONTRAST","code_information":[{"code":"Px00032010157","type":"CDM"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":3284.0,"discounted_cash":1149.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG 2 VIEWS","code_information":[{"code":"Px00032010159","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR LEG INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010161","type":"CDM"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":171.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"Px00032010163","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010165","type":"CDM"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN COMPLETE SERIES","code_information":[{"code":"Px00032010175","type":"CDM"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR PERITONEUM","code_information":[{"code":"Px00032010176","type":"CDM"},{"code":"74190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":556.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY","code_information":[{"code":"Px00032010179","type":"CDM"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010181","type":"CDM"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1930.0,"discounted_cash":675.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010184","type":"CDM"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2025.0,"discounted_cash":708.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SMALL INTESTINE W CONTRAST","code_information":[{"code":"Px00032010187","type":"CDM"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.0,"discounted_cash":474.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010188","type":"CDM"},{"code":"74251","type":"HCPCS"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN PORTABLE 1 VIEW","code_information":[{"code":"Px00032010190","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":290.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR COLON W CONTRAST","code_information":[{"code":"Px00032010191","type":"CDM"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2110.0,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR COLON DOUBLE CONTRAST","code_information":[{"code":"Px00032010192","type":"CDM"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2392.0,"discounted_cash":837.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR COLON ENEMA AIR/CONTRAST BLOCKAGE","code_information":[{"code":"Px00032010193","type":"CDM"},{"code":"74283","type":"HCPCS"}],"standard_charges":[{"gross_charge":2311.0,"discounted_cash":808.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CONTRAST GALLBLADDER","code_information":[{"code":"Px00032010194","type":"CDM"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":363.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCT ENDOSCOPY","code_information":[{"code":"Px00032010201","type":"CDM"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.0,"discounted_cash":656.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BILE/PANC ENDOSCOPY","code_information":[{"code":"Px00032010203","type":"CDM"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.0,"discounted_cash":656.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR GUIDE GI DILATION","code_information":[{"code":"Px00032010206","type":"CDM"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":6845.0,"discounted_cash":2395.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCT DILATION W/WO STENT PLCMT","code_information":[{"code":"Px00032010207","type":"CDM"},{"code":"74363","type":"HCPCS"}],"standard_charges":[{"gross_charge":4549.0,"discounted_cash":1592.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR UROGRAPHY W/WO TOMOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010208","type":"CDM"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1779.0,"discounted_cash":622.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC UROGRAPHY INFUSION W/TOMOGRAPHY","code_information":[{"code":"Px00032010210","type":"CDM"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2659.0,"discounted_cash":930.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR UROGRAPHY RETROGRADE W/WO KUB W CONTRAST","code_information":[{"code":"Px00032010211","type":"CDM"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1410.0,"discounted_cash":493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR UROGRAPHY ANTEGRADE W CONTRAST","code_information":[{"code":"Px00032010212","type":"CDM"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":3050.0,"discounted_cash":1067.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CYSTOGRAPHY MIN 3 VIEWS W CONTRAST","code_information":[{"code":"Px00032010213","type":"CDM"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1161.0,"discounted_cash":406.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR URETHRA/BLADDER RETRO W CONTRAST","code_information":[{"code":"Px00032010216","type":"CDM"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR URETHRA/BLADDER VOIDING","code_information":[{"code":"Px00032010217","type":"CDM"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":423.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR KIDNEY LESION","code_information":[{"code":"Px00032010218","type":"CDM"},{"code":"74470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1852.0,"discounted_cash":648.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR UTERUS & FALLOPIAN TUBE W CONTRAST","code_information":[{"code":"Px00032010223","type":"CDM"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1861.0,"discounted_cash":651.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AORTOGRAPHY THORACIC W/O SERIAL","code_information":[{"code":"Px00032010226","type":"CDM"},{"code":"75600","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":2325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR AORTOGRAPHY THORACIC SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010227","type":"CDM"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":2325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR AORTOGRAPHY ABDOMEN SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010228","type":"CDM"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":5324.0,"discounted_cash":1863.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR AORTOGRAPHY ABD BI ILIOFEM SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010229","type":"CDM"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":2325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO SPINE SELECTIVE W CONTRAST","code_information":[{"code":"Px00032010239","type":"CDM"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":23671.0,"discounted_cash":8284.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO EXTREMITY UNILATERAL W CONTRAST","code_information":[{"code":"Px00032010240","type":"CDM"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":6183.0,"discounted_cash":2164.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIOGRAPHY EXTREMITY BILATERAL RS&I","code_information":[{"code":"Px00032010241","type":"CDM"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":9961.0,"discounted_cash":3486.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO ABDOMEN VISCERAL W CONTRAST","code_information":[{"code":"Px00032010244","type":"CDM"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":9961.0,"discounted_cash":3486.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I","code_information":[{"code":"Px00032010245","type":"CDM"},{"code":"75731","type":"HCPCS"}],"standard_charges":[{"gross_charge":11610.0,"discounted_cash":4063.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ARTERY ADRENALS BILAT","code_information":[{"code":"Px00032010246","type":"CDM"},{"code":"75733","type":"HCPCS"}],"standard_charges":[{"gross_charge":14923.0,"discounted_cash":5223.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO PELVIC W CONTRAST","code_information":[{"code":"Px00032010247","type":"CDM"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":9754.0,"discounted_cash":3413.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO PULMONARY W CONTRAST UNI","code_information":[{"code":"Px00032010248","type":"CDM"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":9961.0,"discounted_cash":3486.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO PULMONARY W CONTRAST BIL","code_information":[{"code":"Px00032010249","type":"CDM"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":14923.0,"discounted_cash":5223.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ARTERY LUNG NON-SELECTIVE","code_information":[{"code":"Px00032010250","type":"CDM"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":9961.0,"discounted_cash":3486.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO MAMMARY INTERNAL","code_information":[{"code":"Px00032010251","type":"CDM"},{"code":"75756","type":"HCPCS"}],"standard_charges":[{"gross_charge":12450.0,"discounted_cash":4357.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO EA ADDITIONAL VESSEL","code_information":[{"code":"Px00032010252","type":"CDM"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":3473.0,"discounted_cash":1215.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR LYMPH VESSEL ARM/LEG","code_information":[{"code":"Px00032010254","type":"CDM"},{"code":"75801","type":"HCPCS"}],"standard_charges":[{"gross_charge":2209.0,"discounted_cash":773.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR LYMPH VESSEL ARMS/LEGS BILAT","code_information":[{"code":"Px00032010255","type":"CDM"},{"code":"75803","type":"HCPCS"}],"standard_charges":[{"gross_charge":4405.0,"discounted_cash":1541.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR LYMPH VESSEL TRUNK","code_information":[{"code":"Px00032010256","type":"CDM"},{"code":"75805","type":"HCPCS"}],"standard_charges":[{"gross_charge":5855.0,"discounted_cash":2049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR LYMPH VESSEL TRUNK BILAT","code_information":[{"code":"Px00032010257","type":"CDM"},{"code":"75807","type":"HCPCS"}],"standard_charges":[{"gross_charge":10984.0,"discounted_cash":3844.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR NONVASCULAR SHUNT","code_information":[{"code":"Px00032010258","type":"CDM"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":368.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEIN SPLEEN/LIVER","code_information":[{"code":"Px00032010259","type":"CDM"},{"code":"75810","type":"HCPCS"}],"standard_charges":[{"gross_charge":8311.0,"discounted_cash":2908.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEINS EXTREMITY UNI W CONTRAST","code_information":[{"code":"Px00032010260","type":"CDM"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":5008.0,"discounted_cash":1752.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEINS EXTREMITY BIL W CONTRAST","code_information":[{"code":"Px00032010261","type":"CDM"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":2325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEINS CAVAL INFERIOR W CONTRAST","code_information":[{"code":"Px00032010262","type":"CDM"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":2325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEINS CAVAL SUPERIOR W CONTRAST","code_information":[{"code":"Px00032010263","type":"CDM"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":2325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEIN KIDNEY UNI W CONTRAST","code_information":[{"code":"Px00032010264","type":"CDM"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":2325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEIN KIDNEYS BILAT","code_information":[{"code":"Px00032010265","type":"CDM"},{"code":"75833","type":"HCPCS"}],"standard_charges":[{"gross_charge":9961.0,"discounted_cash":3486.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEINS VENOUS SINUS W CONTRAST","code_information":[{"code":"Px00032010268","type":"CDM"},{"code":"75860","type":"HCPCS"}],"standard_charges":[{"gross_charge":4142.0,"discounted_cash":1449.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEINS SUP SAGGITAL SINUS W CONTRAST","code_information":[{"code":"Px00032010269","type":"CDM"},{"code":"75870","type":"HCPCS"}],"standard_charges":[{"gross_charge":3107.0,"discounted_cash":1087.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VEIN W/O HEMODYN EVAL","code_information":[{"code":"Px00032010281","type":"CDM"},{"code":"75887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5855.0,"discounted_cash":2049.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR VENOUS SAMPLING W/WO ANGIO","code_information":[{"code":"Px00032010284","type":"CDM"},{"code":"75893","type":"HCPCS"}],"standard_charges":[{"gross_charge":9754.0,"discounted_cash":3413.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR TRANSCATH EMBOLIZ THERAPY W CONTRAST","code_information":[{"code":"Px00032010285","type":"CDM"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":2207.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO EXISTING CATH NO THROMBO","code_information":[{"code":"Px00032010287","type":"CDM"},{"code":"75898","type":"HCPCS"}],"standard_charges":[{"gross_charge":7126.0,"discounted_cash":2494.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE CVA DEVICE OBSTRUCT","code_information":[{"code":"Px00032010289","type":"CDM"},{"code":"75901","type":"HCPCS"}],"standard_charges":[{"gross_charge":4640.0,"discounted_cash":1624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE CVA LUMEN OBSTRUCT","code_information":[{"code":"Px00032010290","type":"CDM"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":4640.0,"discounted_cash":1624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ENDOVASC THOR AORTA REPAIR","code_information":[{"code":"Px00032010297","type":"CDM"},{"code":"75956","type":"HCPCS"}],"standard_charges":[{"gross_charge":14028.0,"discounted_cash":4909.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ENDOVASC THOR AORTA REPAIR SUBCLAV","code_information":[{"code":"Px00032010298","type":"CDM"},{"code":"75957","type":"HCPCS"}],"standard_charges":[{"gross_charge":14028.0,"discounted_cash":4909.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CHANGE TUBE/CATH W CONTRAST","code_information":[{"code":"Px00032010311","type":"CDM"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":3235.0,"discounted_cash":1132.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ABSCESS DRAINAGE W IMG GUIDANCE","code_information":[{"code":"Px00032010312","type":"CDM"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":4399.0,"discounted_cash":1539.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"Px00032010318","type":"CDM"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1988.0,"discounted_cash":695.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR PEDIATRIC FOREIGN BODY 1 VIEW","code_information":[{"code":"Px00032010320","type":"CDM"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":203.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FISTULA/SINUS ABSCESS","code_information":[{"code":"Px00032010321","type":"CDM"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"Px00032010322","type":"CDM"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TOMOGRAPHY SINGLE PLANE","code_information":[{"code":"Px00032010323","type":"CDM"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":571.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CINE/VIDEO","code_information":[{"code":"Px00032010326","type":"CDM"},{"code":"76120","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","code_information":[{"code":"Px00032010330","type":"CDM"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1988.0,"discounted_cash":695.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FL GUIDE PLCMT NEEDLE ADD ON","code_information":[{"code":"Px00032010331","type":"CDM"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLUOROGUIDE FOR SPINE INJECT","code_information":[{"code":"Px00032010332","type":"CDM"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2072.0,"discounted_cash":725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MAMMARY DUCT SINGLE","code_information":[{"code":"Px00032010335","type":"CDM"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":282.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR MAMMARY DUCT MULTIPLE","code_information":[{"code":"Px00032010336","type":"CDM"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1138.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"Px00032010338","type":"CDM"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY COMPLETE","code_information":[{"code":"Px00032010341","type":"CDM"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY INFANT","code_information":[{"code":"Px00032010342","type":"CDM"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1763.0,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR DXA BONE DENSITY STUDY AXIAL","code_information":[{"code":"Px00032010344","type":"CDM"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BONE DENSITY PERIPHERAL SKELETON","code_information":[{"code":"Px00032010345","type":"CDM"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":150.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY CDM","code_information":[{"code":"Px00032010351","type":"CDM"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY CDM","code_information":[{"code":"Px00032010352","type":"CDM"},{"code":"74221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER COMPLETE MIN 2 VIEWS","code_information":[{"code":"Px00032010481","type":"CDM"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 1 VIEW","code_information":[{"code":"Px00032010483","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ STENT/CHEST VERT ART","code_information":[{"code":"Px00032010495","type":"CDM"},{"code":"0075T","type":"HCPCS"}],"standard_charges":[{"gross_charge":19182.0,"discounted_cash":6713.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG LIMITED","code_information":[{"code":"Px00032010499","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 1 VIEW","code_information":[{"code":"Px00032010503","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 1 VIEW","code_information":[{"code":"Px00032010505","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":206.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM 1 VIEW","code_information":[{"code":"Px00032010600","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DXA BONE DENSITY AXIAL WITH VFA","code_information":[{"code":"Px00032010602","type":"CDM"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 1 VIEW","code_information":[{"code":"Px00032010604","type":"CDM"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 2 OR 3 VIEWS","code_information":[{"code":"Px00032010605","type":"CDM"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 4 OR 5 VIEWS","code_information":[{"code":"Px00032010606","type":"CDM"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":339.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE MIN 6 VIEWS","code_information":[{"code":"Px00032010607","type":"CDM"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED 1 VIEW","code_information":[{"code":"Px00032010608","type":"CDM"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS","code_information":[{"code":"Px00032010609","type":"CDM"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":310.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED MIN 4 VIEWS","code_information":[{"code":"Px00032010610","type":"CDM"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED 2 VIEWS","code_information":[{"code":"Px00032010611","type":"CDM"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED 3-4 VIEWS","code_information":[{"code":"Px00032010612","type":"CDM"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":379.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED MIN 5 VIEWS","code_information":[{"code":"Px00032010613","type":"CDM"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.0,"discounted_cash":416.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR 1 VIEW","code_information":[{"code":"Px00032010614","type":"CDM"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":221.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR MIN 2 VIEWS","code_information":[{"code":"Px00032010615","type":"CDM"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"Px00032410014","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":285.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"Px00032410015","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":310.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 3 VIEWS","code_information":[{"code":"Px00032410016","type":"CDM"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":334.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 4/PLUS VIEWS","code_information":[{"code":"Px00032410017","type":"CDM"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XR CHEST PORTABLE 1 VIEW","code_information":[{"code":"Px00032410018","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":285.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO SQ OR IM NON HORMONAL CDM","code_information":[{"code":"Px00033110001","type":"CDM"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO CDM","code_information":[{"code":"Px00033110002","type":"CDM"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV PUSH INITIAL OR SINGLE DRUG CDM","code_information":[{"code":"Px00033110007","type":"CDM"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":1042.0,"discounted_cash":364.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION SIMPLE","code_information":[{"code":"Px00033310006","type":"CDM"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION INTERMEDIATE","code_information":[{"code":"Px00033310007","type":"CDM"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.0,"discounted_cash":701.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION COMPLEX","code_information":[{"code":"Px00033310008","type":"CDM"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2480.0,"discounted_cash":868.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION 3D","code_information":[{"code":"Px00033310009","type":"CDM"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":7589.0,"discounted_cash":2656.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BASIC DOSIMETRY CALC","code_information":[{"code":"Px00033310010","type":"CDM"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":197.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RADIOTHERAPY DOSE PLAN, IMRT","code_information":[{"code":"Px00033310012","type":"CDM"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":5778.0,"discounted_cash":2022.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL RADIATION DOSIMETRY","code_information":[{"code":"Px00033310022","type":"CDM"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES SIMPLE","code_information":[{"code":"Px00033310023","type":"CDM"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":805.0,"discounted_cash":281.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES INTERMEDIATE","code_information":[{"code":"Px00033310024","type":"CDM"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES COMPLEX","code_information":[{"code":"Px00033310025","type":"CDM"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.0,"discounted_cash":704.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONTINUING PHYSICS CONSULT","code_information":[{"code":"Px00033310027","type":"CDM"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DESIGN MLC DEVICE FOR IMRT","code_information":[{"code":"Px00033310028","type":"CDM"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.0,"discounted_cash":466.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL PHYSICS CONSULT","code_information":[{"code":"Px00033310029","type":"CDM"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SRS CRANIAL LINEAR ACCEL 1 SESSION","code_information":[{"code":"Px00033310034","type":"CDM"},{"code":"77372","type":"HCPCS"}],"standard_charges":[{"gross_charge":18137.0,"discounted_cash":6347.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SBRT DELIVERY","code_information":[{"code":"Px00033310035","type":"CDM"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":10480.0,"discounted_cash":3668.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PORT VERIF FILMS PER 5 FRACTNS","code_information":[{"code":"Px00033310051","type":"CDM"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPECIAL RADIATION TREATMENT","code_information":[{"code":"Px00033310057","type":"CDM"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4645.0,"discounted_cash":1625.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPLY INTRCAV RADIAT SIMPLE","code_information":[{"code":"Px00033310059","type":"CDM"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.0,"discounted_cash":893.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPLY INTRCAV RADIAT INTERM","code_information":[{"code":"Px00033310060","type":"CDM"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3785.0,"discounted_cash":1324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPLY INTRCAV RADIAT COMPL","code_information":[{"code":"Px00033310061","type":"CDM"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":6303.0,"discounted_cash":2206.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPLY INTERSTITIAL RAD SRC COMPLX","code_information":[{"code":"Px00033310064","type":"CDM"},{"code":"77778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10150.0,"discounted_cash":3552.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPLY SURFACE RADIATION","code_information":[{"code":"Px00033310073","type":"CDM"},{"code":"77789","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":342.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RADIATION HANDLING","code_information":[{"code":"Px00033310074","type":"CDM"},{"code":"77790","type":"HCPCS"}],"standard_charges":[{"gross_charge":1375.0,"discounted_cash":481.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT INTERSTITIAL MARKERS ABDOMINAL/PELVIC FOR RAD THERAPY","code_information":[{"code":"Px00033310085","type":"CDM"},{"code":"49411","type":"HCPCS"}],"standard_charges":[{"gross_charge":4325.0,"discounted_cash":1513.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RESPIRATOR MOTION MGMT SIMUL","code_information":[{"code":"Px00033310090","type":"CDM"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":2676.0,"discounted_cash":936.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TELETHX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310091","type":"CDM"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":263.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TELETHX ISODOSE PLAN COMPLEX","code_information":[{"code":"Px00033310092","type":"CDM"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.0,"discounted_cash":403.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310093","type":"CDM"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":291.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE INTERMEDIATE","code_information":[{"code":"Px00033310094","type":"CDM"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.0,"discounted_cash":547.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE COMPLEX","code_information":[{"code":"Px00033310095","type":"CDM"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":1824.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMRT DELIVERY SIMPLE","code_information":[{"code":"Px00033310096","type":"CDM"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2005.0,"discounted_cash":701.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMRT DELIVERY COMPLEX","code_information":[{"code":"Px00033310097","type":"CDM"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":2508.0,"discounted_cash":877.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","code_information":[{"code":"Px00033310098","type":"CDM"},{"code":"77387","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":211.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RAD TX SIMPLE","code_information":[{"code":"Px00033310099","type":"CDM"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RAD TX INTERMEDIATE","code_information":[{"code":"Px00033310100","type":"CDM"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RAD TX COMPLEX","code_information":[{"code":"Px00033310101","type":"CDM"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":521.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRACHTX 1 CHANNEL","code_information":[{"code":"Px00033320002","type":"CDM"},{"code":"77770","type":"HCPCS"}],"standard_charges":[{"gross_charge":3603.0,"discounted_cash":1261.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRCHTX 2-12 CHANNELS","code_information":[{"code":"Px00033320003","type":"CDM"},{"code":"77771","type":"HCPCS"}],"standard_charges":[{"gross_charge":5034.0,"discounted_cash":1761.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRCHTX OVER 12 CHANNELS","code_information":[{"code":"Px00033320004","type":"CDM"},{"code":"77772","type":"HCPCS"}],"standard_charges":[{"gross_charge":5794.0,"discounted_cash":2027.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV PUSH ADDL DRUG CDM","code_information":[{"code":"Px00033510002","type":"CDM"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":1042.0,"discounted_cash":364.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00033510003","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1933.0,"discounted_cash":676.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION ADDL HR CDM","code_information":[{"code":"Px00033510004","type":"CDM"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION EA ADDL SEQ DRG CDM","code_information":[{"code":"Px00033510006","type":"CDM"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO ADMIN IA PUSH CDM","code_information":[{"code":"Px00033510008","type":"CDM"},{"code":"96420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":397.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV ADMIN INTO CNS INC LUMBAR PUNCTURE CDM","code_information":[{"code":"Px00033510014","type":"CDM"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.0,"discounted_cash":389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM BONE MARROW LTD","code_information":[{"code":"Px00034010002","type":"CDM"},{"code":"78102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2450.0,"discounted_cash":857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION DIFF","code_information":[{"code":"Px00034010009","type":"CDM"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":2860.0,"discounted_cash":1001.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM","code_information":[{"code":"Px00034010010","type":"CDM"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":3283.0,"discounted_cash":1149.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYOCARD INNERVATION IMAGING","code_information":[{"code":"Px00034010014","type":"CDM"},{"code":"0331T","type":"HCPCS"}],"standard_charges":[{"gross_charge":5574.0,"discounted_cash":1950.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYOCARD INNERVATION IMG W/SPEC","code_information":[{"code":"Px00034010015","type":"CDM"},{"code":"0332T","type":"HCPCS"}],"standard_charges":[{"gross_charge":5758.0,"discounted_cash":2015.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THYROID MET IMAGING LIMITED","code_information":[{"code":"Px00034110006","type":"CDM"},{"code":"78015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1283.0,"discounted_cash":449.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THYROID MET IMAGING WHOLE BODY","code_information":[{"code":"Px00034110007","type":"CDM"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":3844.0,"discounted_cash":1345.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM PARATHYROID","code_information":[{"code":"Px00034110009","type":"CDM"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2748.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ADRENAL IMAGING","code_information":[{"code":"Px00034110010","type":"CDM"},{"code":"78075","type":"HCPCS"}],"standard_charges":[{"gross_charge":4077.0,"discounted_cash":1426.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW IMAGING MULTIPLE","code_information":[{"code":"Px00034110012","type":"CDM"},{"code":"78103","type":"HCPCS"}],"standard_charges":[{"gross_charge":2450.0,"discounted_cash":857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPLEEN IMAGING","code_information":[{"code":"Px00034110020","type":"CDM"},{"code":"78185","type":"HCPCS"}],"standard_charges":[{"gross_charge":2699.0,"discounted_cash":944.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM LYMPH SYSTEM","code_information":[{"code":"Px00034110021","type":"CDM"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":814.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LIVER IMAGING STATIC","code_information":[{"code":"Px00034110023","type":"CDM"},{"code":"78201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2580.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM LIVER SPLEEN STATIC ONLY","code_information":[{"code":"Px00034110027","type":"CDM"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.0,"discounted_cash":1138.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LIVER & SPLEEN IMAGE W/ VASCULAR FLOW","code_information":[{"code":"Px00034110028","type":"CDM"},{"code":"78216","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.0,"discounted_cash":1184.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110030","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":3283.0,"discounted_cash":1149.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SERIAL SALIVARY IMAGING","code_information":[{"code":"Px00034110033","type":"CDM"},{"code":"78231","type":"HCPCS"}],"standard_charges":[{"gross_charge":3034.0,"discounted_cash":1061.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGEAL MOTILITY STUDY","code_information":[{"code":"Px00034110034","type":"CDM"},{"code":"78258","type":"HCPCS"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":803.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM GASTROESOPHAGEAL REFLUX STUDY","code_information":[{"code":"Px00034110036","type":"CDM"},{"code":"78262","type":"HCPCS"}],"standard_charges":[{"gross_charge":2359.0,"discounted_cash":825.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING IMG STDY","code_information":[{"code":"Px00034110037","type":"CDM"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":3844.0,"discounted_cash":1345.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC KIDNEY IMAGING MORPHOLOGY","code_information":[{"code":"Px00034110041","type":"CDM"},{"code":"78700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":861.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM ACUTE GI BLEED STUDY","code_information":[{"code":"Px00034110042","type":"CDM"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":3279.0,"discounted_cash":1147.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM INTESTINE MECKEL VOLVULUS","code_information":[{"code":"Px00034110044","type":"CDM"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2939.0,"discounted_cash":1028.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM PERITONEAL VENOUS SHUNT PATENCY","code_information":[{"code":"Px00034110045","type":"CDM"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":2495.0,"discounted_cash":873.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND OR JOINT IMAGING MULTIPLE AREAS CDM","code_information":[{"code":"Px00034110048","type":"CDM"},{"code":"78305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2628.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM","code_information":[{"code":"Px00034110049","type":"CDM"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":4011.0,"discounted_cash":1403.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM BONE AND ORJOINT IMAGING 3 PHASE STUDY CDM","code_information":[{"code":"Px00034110050","type":"CDM"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":9762.0,"discounted_cash":3416.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM CARDIAC SHUNT","code_information":[{"code":"Px00034110053","type":"CDM"},{"code":"78428","type":"HCPCS"}],"standard_charges":[{"gross_charge":3453.0,"discounted_cash":1208.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT SINGLE","code_information":[{"code":"Px00034110055","type":"CDM"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":5241.0,"discounted_cash":1834.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT MULTIPLE","code_information":[{"code":"Px00034110056","type":"CDM"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":6703.0,"discounted_cash":2346.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYOCARDIAL IMAGE PLANAR MULTIPLE","code_information":[{"code":"Px00034110058","type":"CDM"},{"code":"78454","type":"HCPCS"}],"standard_charges":[{"gross_charge":6703.0,"discounted_cash":2346.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEART INFARCT IMAGE (3D)","code_information":[{"code":"Px00034110063","type":"CDM"},{"code":"78469","type":"HCPCS"}],"standard_charges":[{"gross_charge":1366.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM CARDIAC BLOOD POOL SINGLE","code_information":[{"code":"Px00034110064","type":"CDM"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":5297.0,"discounted_cash":1853.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION PARTICULATE","code_information":[{"code":"Px00034110070","type":"CDM"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":3549.0,"discounted_cash":1242.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PULMONARY VENTILATION IMAGING","code_information":[{"code":"Px00034110072","type":"CDM"},{"code":"78579","type":"HCPCS"}],"standard_charges":[{"gross_charge":3549.0,"discounted_cash":1242.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT IMAGING","code_information":[{"code":"Px00034110073","type":"CDM"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":3938.0,"discounted_cash":1378.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT DIFF","code_information":[{"code":"Px00034110077","type":"CDM"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM BRAIN W VASCULAR FLOW LT 4 VIEWS","code_information":[{"code":"Px00034110080","type":"CDM"},{"code":"78601","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.0,"discounted_cash":668.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BRAIN IMAGE W/FLOW 4/PLUS VIEWS COMPLETE","code_information":[{"code":"Px00034110082","type":"CDM"},{"code":"78606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.0,"discounted_cash":668.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM CSF FLOW CISTERNOGRAM","code_information":[{"code":"Px00034110085","type":"CDM"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":3458.0,"discounted_cash":1210.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM KIDNEY VASC FLOW FUNC WO DRUG","code_information":[{"code":"Px00034110093","type":"CDM"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":2467.0,"discounted_cash":863.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM KIDNEY VASC FLOW FUNC W DRUG","code_information":[{"code":"Px00034110094","type":"CDM"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":2467.0,"discounted_cash":863.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM","code_information":[{"code":"Px00034110099","type":"CDM"},{"code":"78740","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":814.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING CDM","code_information":[{"code":"Px00034110102","type":"CDM"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3034.0,"discounted_cash":1061.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM RP LOCLZJ TUM PLNR GTE 2 AREA GTE 1 D IMG OR 1 AREA IMG GT 2 D CDM","code_information":[{"code":"Px00034110103","type":"CDM"},{"code":"78801","type":"HCPCS"}],"standard_charges":[{"gross_charge":3034.0,"discounted_cash":1061.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING CDM","code_information":[{"code":"Px00034110104","type":"CDM"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":4695.0,"discounted_cash":1643.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG CDM","code_information":[{"code":"Px00034110105","type":"CDM"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":5395.0,"discounted_cash":1888.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM TUMOR LCLZN WB GTE 2 DAYS","code_information":[{"code":"Px00034110106","type":"CDM"},{"code":"78804","type":"HCPCS"}],"standard_charges":[{"gross_charge":5045.0,"discounted_cash":1765.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110132","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":3283.0,"discounted_cash":1149.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","code_information":[{"code":"Px00034110142","type":"CDM"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THYROID IMAGING WITH VASCULAR FLOW","code_information":[{"code":"Px00034110143","type":"CDM"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THYROID IMAGING W OR W/O VASC FLOW W/UPTAKE SINGLE/MULT QUAN MEA","code_information":[{"code":"Px00034110144","type":"CDM"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1887.0,"discounted_cash":660.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","code_information":[{"code":"Px00034110145","type":"CDM"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2232.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT","code_information":[{"code":"Px00034110146","type":"CDM"},{"code":"78072","type":"HCPCS"}],"standard_charges":[{"gross_charge":6697.0,"discounted_cash":2343.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG CDM","code_information":[{"code":"Px00034110149","type":"CDM"},{"code":"78830","type":"HCPCS"}],"standard_charges":[{"gross_charge":5747.0,"discounted_cash":2011.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG CDM","code_information":[{"code":"Px00034110150","type":"CDM"},{"code":"78831","type":"HCPCS"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2044.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG CDM","code_information":[{"code":"Px00034110151","type":"CDM"},{"code":"78832","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.0,"discounted_cash":2317.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING SB TRANSIT","code_information":[{"code":"Px00034130006","type":"CDM"},{"code":"78265","type":"HCPCS"}],"standard_charges":[{"gross_charge":3844.0,"discounted_cash":1345.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPT SB/COL MULTIPLE DAYS","code_information":[{"code":"Px00034130007","type":"CDM"},{"code":"78266","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1478.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RADIOPHARM THERAPY, BY ORAL ADMIN","code_information":[{"code":"Px00034210001","type":"CDM"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":5123.0,"discounted_cash":1793.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV RADIOPHARM ADMIN","code_information":[{"code":"Px00034210002","type":"CDM"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":2867.0,"discounted_cash":1003.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RADPHARM THER INTRA-ART PARTICULT","code_information":[{"code":"Px00034210007","type":"CDM"},{"code":"79445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":358.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL W/O DYE LIMITED","code_information":[{"code":"Px00035010003","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":5126.0,"discounted_cash":1794.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL WO & W CONTRAST","code_information":[{"code":"Px00035010006","type":"CDM"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":6547.0,"discounted_cash":2291.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK WO CONTRAST","code_information":[{"code":"Px00035010007","type":"CDM"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":6882.0,"discounted_cash":2408.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W CONTRAST","code_information":[{"code":"Px00035010008","type":"CDM"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":8018.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W & W/O CONTRAST","code_information":[{"code":"Px00035010009","type":"CDM"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":8481.0,"discounted_cash":2968.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY NECK W CONTRAST","code_information":[{"code":"Px00035010010","type":"CDM"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":5013.0,"discounted_cash":1754.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT THORAX WO CONTRAST","code_information":[{"code":"Px00035010011","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":4379.0,"discounted_cash":1532.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY CHEST","code_information":[{"code":"Px00035010013","type":"CDM"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT LWR EXTREMITY WO & W CONTRAST","code_information":[{"code":"Px00035010018","type":"CDM"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":5152.0,"discounted_cash":1803.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO LWR EXTR W/O&W/DYE","code_information":[{"code":"Px00035010020","type":"CDM"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3681.0,"discounted_cash":1288.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035010023","type":"CDM"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":5486.0,"discounted_cash":1920.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ABD & PELVIS WO CONTRAST","code_information":[{"code":"Px00035010024","type":"CDM"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":6569.0,"discounted_cash":2299.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W  CONTRAST","code_information":[{"code":"Px00035010025","type":"CDM"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":7724.0,"discounted_cash":2703.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST","code_information":[{"code":"Px00035010027","type":"CDM"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.0,"discounted_cash":450.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART W/3D IMAGE W/ CONTRAST","code_information":[{"code":"Px00035010028","type":"CDM"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":3681.0,"discounted_cash":1288.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART CONGENITAL W/3D IMAGE W/CONTRAST","code_information":[{"code":"Px00035010029","type":"CDM"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3681.0,"discounted_cash":1288.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST","code_information":[{"code":"Px00035010030","type":"CDM"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":3681.0,"discounted_cash":1288.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CTA AORTA BIL ILIOFEM W & W/O CONTRAST","code_information":[{"code":"Px00035010031","type":"CDM"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC 3D RENDERING W/POSTPROCESS","code_information":[{"code":"Px00035010033","type":"CDM"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":203.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT SCAN FOLLOW-UP STUDY LIMITED","code_information":[{"code":"Px00035010034","type":"CDM"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1573.0,"discounted_cash":550.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE STEREOTACTIC LOCALIZATION","code_information":[{"code":"Px00035010036","type":"CDM"},{"code":"77011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2929.0,"discounted_cash":1025.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE PLCMT NEEDLE","code_information":[{"code":"Px00035010037","type":"CDM"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3027.0,"discounted_cash":1059.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE FOR TISSUE ABLATION","code_information":[{"code":"Px00035010038","type":"CDM"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":3001.0,"discounted_cash":1050.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE PLCMT RAD FIELD","code_information":[{"code":"Px00035010039","type":"CDM"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":506.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT COLONOGRAPHY DX","code_information":[{"code":"Px00035010063","type":"CDM"},{"code":"74261","type":"HCPCS"}],"standard_charges":[{"gross_charge":4512.0,"discounted_cash":1579.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN PELVIS","code_information":[{"code":"Px00035010072","type":"CDM"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":6857.0,"discounted_cash":2399.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CTA HEAD&NECK W/NONCONTRAST IMG&POST-PXESSING CDM","code_information":[{"code":"Px00035100001","type":"CDM"},{"code":"70471","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.0,"discounted_cash":415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT CERE PRFUJ ALYS W/CT/CTA SAME ANATOMY CDM","code_information":[{"code":"Px00035100002","type":"CDM"},{"code":"70472","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.0,"discounted_cash":415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT CERE PRFUJ ALYS W/O CT/CTA SAME ANATOMY CDM","code_information":[{"code":"Px00035100003","type":"CDM"},{"code":"70473","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.0,"discounted_cash":415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT PERFUSION W/CONTRAST CBF","code_information":[{"code":"Px00035110001","type":"CDM"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.0,"discounted_cash":415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN WO CONTRAST","code_information":[{"code":"Px00035110002","type":"CDM"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":4079.0,"discounted_cash":1427.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W CONTRAST","code_information":[{"code":"Px00035110007","type":"CDM"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":5011.0,"discounted_cash":1753.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W & W/O CONTRAST","code_information":[{"code":"Px00035110012","type":"CDM"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":2038.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA WO CONTRAST","code_information":[{"code":"Px00035110014","type":"CDM"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":5126.0,"discounted_cash":1794.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W CONTRAST","code_information":[{"code":"Px00035110017","type":"CDM"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":6080.0,"discounted_cash":2128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W & W/O CONTRAST","code_information":[{"code":"Px00035110019","type":"CDM"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":6547.0,"discounted_cash":2291.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL WO CONTRAST","code_information":[{"code":"Px00035110022","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":5126.0,"discounted_cash":1794.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL W CONTRAST","code_information":[{"code":"Px00035110030","type":"CDM"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":6080.0,"discounted_cash":2128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"Px00035110032","type":"CDM"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":5013.0,"discounted_cash":1754.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM","code_information":[{"code":"Px00035200001","type":"CDM"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W CONTRAST","code_information":[{"code":"Px00035210003","type":"CDM"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W & W/O CONTRAST","code_information":[{"code":"Px00035210006","type":"CDM"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5492.0,"discounted_cash":1922.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE WO CONTRAST","code_information":[{"code":"Px00035210008","type":"CDM"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":6882.0,"discounted_cash":2408.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE W/DYE","code_information":[{"code":"Px00035210009","type":"CDM"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":8018.0,"discounted_cash":2806.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210010","type":"CDM"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":8162.0,"discounted_cash":2856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE WO CONTRAST","code_information":[{"code":"Px00035210011","type":"CDM"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":5946.0,"discounted_cash":2081.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W CONTRAST","code_information":[{"code":"Px00035210012","type":"CDM"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210013","type":"CDM"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":6867.0,"discounted_cash":2403.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE WO CONTRAST","code_information":[{"code":"Px00035210014","type":"CDM"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":5151.0,"discounted_cash":1802.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W CONTRAST","code_information":[{"code":"Px00035210015","type":"CDM"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":5581.0,"discounted_cash":1953.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210016","type":"CDM"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":5995.0,"discounted_cash":2098.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CTA PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210017","type":"CDM"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":1545.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"Px00035210018","type":"CDM"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":4305.0,"discounted_cash":1506.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"Px00035210020","type":"CDM"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":5069.0,"discounted_cash":1774.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210024","type":"CDM"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":5403.0,"discounted_cash":1891.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210029","type":"CDM"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2848.0,"discounted_cash":996.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210030","type":"CDM"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":4074.0,"discounted_cash":1425.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210031","type":"CDM"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":3681.0,"discounted_cash":1288.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT UPPR EXTREMITY W & W/O CONTRAST","code_information":[{"code":"Px00035210034","type":"CDM"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":4271.0,"discounted_cash":1494.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO UPR EXTRM W & W/O CONTRAST","code_information":[{"code":"Px00035210037","type":"CDM"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3681.0,"discounted_cash":1288.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"Px00035210038","type":"CDM"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":4379.0,"discounted_cash":1532.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210040","type":"CDM"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":5035.0,"discounted_cash":1762.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"Px00035210046","type":"CDM"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035210047","type":"CDM"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":5486.0,"discounted_cash":1920.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210054","type":"CDM"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":8228.0,"discounted_cash":2879.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT COLONOGRAPHY DX W/DYE","code_information":[{"code":"Px00035210059","type":"CDM"},{"code":"74262","type":"HCPCS"}],"standard_charges":[{"gross_charge":5149.0,"discounted_cash":1802.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W/O DYE F/U LUNG SCREENING","code_information":[{"code":"Px00035210105","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":4379.0,"discounted_cash":1532.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ROBOTIC SURGICAL SYSTEM CDM","code_information":[{"code":"Px00036000019","type":"CDM"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RT BRONCH LEVEL 1 CDM","code_information":[{"code":"Px00036000021","type":"CDM"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 2 CDM","code_information":[{"code":"Px00036000022","type":"CDM"}],"standard_charges":[{"gross_charge":5671.0,"discounted_cash":1984.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 3 CDM","code_information":[{"code":"Px00036000023","type":"CDM"}],"standard_charges":[{"gross_charge":6693.0,"discounted_cash":2342.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 4 CDM","code_information":[{"code":"Px00036000024","type":"CDM"}],"standard_charges":[{"gross_charge":8318.0,"discounted_cash":2911.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 5 CDM","code_information":[{"code":"Px00036000025","type":"CDM"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":4996.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 6 CDM","code_information":[{"code":"Px00036000026","type":"CDM"}],"standard_charges":[{"gross_charge":17104.0,"discounted_cash":5986.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC REPLACE AORTIC VALVE PERC TRANSCAROTID ARTERY APPROACH CDM","code_information":[{"code":"Px00036000027","type":"CDM"},{"code":"36000027","type":"HCPCS"}],"standard_charges":[{"gross_charge":26091.0,"discounted_cash":9131.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 1","code_information":[{"code":"Px00036010001","type":"CDM"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 2","code_information":[{"code":"Px00036010002","type":"CDM"}],"standard_charges":[{"gross_charge":3370.0,"discounted_cash":1179.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 3","code_information":[{"code":"Px00036010003","type":"CDM"}],"standard_charges":[{"gross_charge":4339.0,"discounted_cash":1518.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 4","code_information":[{"code":"Px00036010004","type":"CDM"}],"standard_charges":[{"gross_charge":5896.0,"discounted_cash":2063.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 5","code_information":[{"code":"Px00036010005","type":"CDM"}],"standard_charges":[{"gross_charge":9400.0,"discounted_cash":3290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT","code_information":[{"code":"Px00036010060","type":"CDM"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":17120.0,"discounted_cash":5992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHANGE URETER STENT PERCUT","code_information":[{"code":"Px00036010061","type":"CDM"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":7522.0,"discounted_cash":2632.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE URETER STENT PERCUT","code_information":[{"code":"Px00036010062","type":"CDM"},{"code":"50384","type":"HCPCS"}],"standard_charges":[{"gross_charge":4287.0,"discounted_cash":1500.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHANGE EXT/INT URETER STENT","code_information":[{"code":"Px00036010063","type":"CDM"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":7242.0,"discounted_cash":2534.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE RENAL TUBE W/FLUORO","code_information":[{"code":"Px00036010064","type":"CDM"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":7864.0,"discounted_cash":2752.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC TEMPORY VESSEL OCCL","code_information":[{"code":"Px00036010067","type":"CDM"},{"code":"61623","type":"HCPCS"}],"standard_charges":[{"gross_charge":64339.0,"discounted_cash":22518.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL C/T","code_information":[{"code":"Px00036010069","type":"CDM"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJS TRANSFOR CER/THOR EA ADD LVL","code_information":[{"code":"Px00036010070","type":"CDM"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL L/S","code_information":[{"code":"Px00036010071","type":"CDM"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJS TRANSFOR L/S EA ADD LV COMP","code_information":[{"code":"Px00036010072","type":"CDM"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT C/T 3 LEV","code_information":[{"code":"Px00036010073","type":"CDM"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":8351.0,"discounted_cash":2922.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECT FOR LYMPHATIC X-RAY","code_information":[{"code":"Px00036010101","type":"CDM"},{"code":"38790","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.0,"discounted_cash":334.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY OF LIVER","code_information":[{"code":"Px00036010104","type":"CDM"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"Px00036010107","type":"CDM"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF BREAST LESION","code_information":[{"code":"Px00036010111","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN BREAST LESION ADD-ON","code_information":[{"code":"Px00036010112","type":"CDM"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BREAST X-RAY DUCTOGRAM OR GALACTOGRAM","code_information":[{"code":"Px00036010114","type":"CDM"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":156.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BX MUSCLE","code_information":[{"code":"Px00036010123","type":"CDM"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECT SINUS TRACT FOR X-RAY PROC","code_information":[{"code":"Px00036010128","type":"CDM"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ TENDON ORIGIN/INSERTION","code_information":[{"code":"Px00036010129","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE","code_information":[{"code":"Px00036010130","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE","code_information":[{"code":"Px00036010131","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00036010132","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SHOULDER X-RAY","code_information":[{"code":"Px00036010133","type":"CDM"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":542.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 1ST 30 MINS","code_information":[{"code":"Px00036010146","type":"CDM"}],"standard_charges":[{"gross_charge":2392.0,"discounted_cash":837.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 1ST 30 MINS","code_information":[{"code":"Px00036010147","type":"CDM"}],"standard_charges":[{"gross_charge":8961.0,"discounted_cash":3136.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 1ST 30 MINS","code_information":[{"code":"Px00036010148","type":"CDM"}],"standard_charges":[{"gross_charge":10802.0,"discounted_cash":3780.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 1ST 30 MINS","code_information":[{"code":"Px00036010149","type":"CDM"}],"standard_charges":[{"gross_charge":17850.0,"discounted_cash":6247.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 1ST 30 MINS","code_information":[{"code":"Px00036010150","type":"CDM"}],"standard_charges":[{"gross_charge":18743.0,"discounted_cash":6560.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 1ST 30 MINS","code_information":[{"code":"Px00036010151","type":"CDM"}],"standard_charges":[{"gross_charge":19264.0,"discounted_cash":6742.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS","code_information":[{"code":"Px00036010152","type":"CDM"}],"standard_charges":[{"gross_charge":20194.0,"discounted_cash":7067.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 1ST 30 MINS","code_information":[{"code":"Px00036010153","type":"CDM"}],"standard_charges":[{"gross_charge":28103.0,"discounted_cash":9836.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRCATH REPLACE AORTIC VALVE","code_information":[{"code":"Px00036010178","type":"CDM"},{"code":"33366","type":"HCPCS"}],"standard_charges":[{"gross_charge":68160.0,"discounted_cash":23856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC VISC AORTA 1 GRAFT","code_information":[{"code":"Px00036010179","type":"CDM"},{"code":"34841","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC VISC AORTA 2 GRAFT","code_information":[{"code":"Px00036010180","type":"CDM"},{"code":"34842","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC VISC AORTA 3 GRAFT","code_information":[{"code":"Px00036010181","type":"CDM"},{"code":"34843","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC VISC AORTA 4 GRAFT","code_information":[{"code":"Px00036010182","type":"CDM"},{"code":"34844","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VISC & INFRAREN ABD 1 PROSTH","code_information":[{"code":"Px00036010183","type":"CDM"},{"code":"34845","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VISC & INFRAREN ABD 2 PROSTH","code_information":[{"code":"Px00036010184","type":"CDM"},{"code":"34846","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VISC & INFRAREN ABD 3 PROSTH","code_information":[{"code":"Px00036010185","type":"CDM"},{"code":"34847","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VISC & INFRAREN ABD 4+ PROST","code_information":[{"code":"Px00036010186","type":"CDM"},{"code":"34848","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACE STENT 1ST ARTERY","code_information":[{"code":"Px00036010188","type":"CDM"},{"code":"37236","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACE STENT EA ADD ARTERY","code_information":[{"code":"Px00036010189","type":"CDM"},{"code":"37237","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACE STENT 1ST VEIN","code_information":[{"code":"Px00036010190","type":"CDM"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL","code_information":[{"code":"Px00036010191","type":"CDM"},{"code":"37239","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VENOUS","code_information":[{"code":"Px00036010192","type":"CDM"},{"code":"37241","type":"HCPCS"}],"standard_charges":[{"gross_charge":25204.0,"discounted_cash":8821.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ARTERY","code_information":[{"code":"Px00036010193","type":"CDM"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":25721.0,"discounted_cash":9002.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ORGAN","code_information":[{"code":"Px00036010194","type":"CDM"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":25721.0,"discounted_cash":9002.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VASC EMBOLIZE/OCCLUDE BLEED","code_information":[{"code":"Px00036010195","type":"CDM"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":25721.0,"discounted_cash":9002.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT VISCERA","code_information":[{"code":"Px00036010196","type":"CDM"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":17120.0,"discounted_cash":5992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT PERI/RETRO","code_information":[{"code":"Px00036010197","type":"CDM"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":17120.0,"discounted_cash":5992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT TRNS/REC/VAG","code_information":[{"code":"Px00036010198","type":"CDM"},{"code":"49407","type":"HCPCS"}],"standard_charges":[{"gross_charge":17120.0,"discounted_cash":5992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 PER MIN","code_information":[{"code":"Px00036010212","type":"CDM"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 PER MIN","code_information":[{"code":"Px00036010214","type":"CDM"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 PER MIN","code_information":[{"code":"Px00036010216","type":"CDM"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":45.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 PER MIN","code_information":[{"code":"Px00036010218","type":"CDM"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 PER MIN","code_information":[{"code":"Px00036010220","type":"CDM"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":92.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 PER MIN","code_information":[{"code":"Px00036010222","type":"CDM"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 PER MIN","code_information":[{"code":"Px00036010224","type":"CDM"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 PER MIN","code_information":[{"code":"Px00036010226","type":"CDM"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMODENERV 1 EXT 1-4 MUSC","code_information":[{"code":"Px00036010236","type":"CDM"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":909.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMODENERV 1 EXT 1-4 EA ADD EXT","code_information":[{"code":"Px00036010237","type":"CDM"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":909.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMODENER 1 EXT 5 OR MORE MUSCLES","code_information":[{"code":"Px00036010238","type":"CDM"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":909.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMODENER 1 EXT EA ADDL 5 OR MORE MUSCLES","code_information":[{"code":"Px00036010239","type":"CDM"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":909.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMODENERV TRUNK MUSC 1-5","code_information":[{"code":"Px00036010240","type":"CDM"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":909.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHEMODENERV TRUNK MUSC 6/>","code_information":[{"code":"Px00036010241","type":"CDM"},{"code":"64647","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":909.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC TRNSCTH MTRAL VLVE REPAIR CS APPRCH","code_information":[{"code":"Px00036010245","type":"CDM"},{"code":"0345T","type":"HCPCS"}],"standard_charges":[{"gross_charge":68160.0,"discounted_cash":23856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SALIVARY X-RAY","code_information":[{"code":"Px00036010324","type":"CDM"},{"code":"42550","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF SALIVARY GLAND, NEEDLE","code_information":[{"code":"Px00036010331","type":"CDM"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"Px00036010345","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF THYROID","code_information":[{"code":"Px00036010349","type":"CDM"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASPIRATION AND/OR INJECTION THYROID CYST CDM","code_information":[{"code":"Px00036010350","type":"CDM"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN SPINAL CORD CYST","code_information":[{"code":"Px00036010352","type":"CDM"},{"code":"62268","type":"HCPCS"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":1694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMPLANT NEUROELECTRODES PERQ EPIDURAL","code_information":[{"code":"Px00036010353","type":"CDM"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":37271.0,"discounted_cash":13044.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INFUS THERP ART/VEN SBQ EXCGH","code_information":[{"code":"Px00036010365","type":"CDM"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":11274.0,"discounted_cash":3945.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INFUS THERP ART/VEN SBQ REMVL","code_information":[{"code":"Px00036010366","type":"CDM"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":13295.0,"discounted_cash":4653.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 6","code_information":[{"code":"Px00036010371","type":"CDM"}],"standard_charges":[{"gross_charge":10011.0,"discounted_cash":3503.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC TRANSCATH RETRIEVAL FB COMPL","code_information":[{"code":"Px00036010378","type":"CDM"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":22542.0,"discounted_cash":7889.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW BIOPSY","code_information":[{"code":"Px00036010406","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY DIAGNOSTIC","code_information":[{"code":"Px00036010413","type":"CDM"}],"standard_charges":[{"gross_charge":6390.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EUS W/ COLONOSCOPY","code_information":[{"code":"Px00036010441","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EUS W/ SIGMOIDOSCOPY","code_information":[{"code":"Px00036010442","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIS TRNFR S/A/L 10.1-30 SQCM","code_information":[{"code":"Px00036010549","type":"CDM"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":6420.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC CDM","code_information":[{"code":"Px00036010901","type":"CDM"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS CDM","code_information":[{"code":"Px00036010936","type":"CDM"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":6779.0,"discounted_cash":2372.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC C-SECTION","code_information":[{"code":"Px00036010960","type":"CDM"}],"standard_charges":[{"gross_charge":12728.0,"discounted_cash":4454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEWBORN STABILIZATION AT DELIVERY - RESP THER CDM","code_information":[{"code":"Px00036010965","type":"CDM"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC C-SECTION MULTI","code_information":[{"code":"Px00036010966","type":"CDM"}],"standard_charges":[{"gross_charge":14637.0,"discounted_cash":5122.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR ELBOW X-RAY","code_information":[{"code":"Px00036011001","type":"CDM"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":304.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HIP ARTHROGRAM PROC","code_information":[{"code":"Px00036011002","type":"CDM"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":304.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/OR LESS CDM","code_information":[{"code":"Px00036011216","type":"CDM"},{"code":"14000","type":"HCPCS"}],"standard_charges":[{"gross_charge":4230.0,"discounted_cash":1480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS PCMKR GEN W EXIST MULT LEADS","code_information":[{"code":"Px00036012001","type":"CDM"},{"code":"33221","type":"HCPCS"}],"standard_charges":[{"gross_charge":29502.0,"discounted_cash":10325.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMV & RPLC PCMK GEN SNG LEAD SYST","code_information":[{"code":"Px00036012002","type":"CDM"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":24315.0,"discounted_cash":8510.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMV & RPLC PCMK GEN DUAL LEAD SYS","code_information":[{"code":"Px00036012003","type":"CDM"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":38855.0,"discounted_cash":13599.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMV&RPLC PCMK GEN MULT LEAD SYS","code_information":[{"code":"Px00036012004","type":"CDM"},{"code":"33229","type":"HCPCS"}],"standard_charges":[{"gross_charge":37891.0,"discounted_cash":13261.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS ICD GEN ONLY W EXIST 2 LDS","code_information":[{"code":"Px00036012005","type":"CDM"},{"code":"33230","type":"HCPCS"}],"standard_charges":[{"gross_charge":25228.0,"discounted_cash":8829.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS ICD GEN ONLY W EXIST MULT LDS","code_information":[{"code":"Px00036012006","type":"CDM"},{"code":"33231","type":"HCPCS"}],"standard_charges":[{"gross_charge":25228.0,"discounted_cash":8829.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMV&RPLC ICD GEN SING LEAD SYST","code_information":[{"code":"Px00036012007","type":"CDM"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":33616.0,"discounted_cash":11765.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMV&RPLC ICD GEN DUAL LEAD SYST","code_information":[{"code":"Px00036012008","type":"CDM"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":34471.0,"discounted_cash":12064.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMV&RPLC ICD GEN MULT LEAD SYST","code_information":[{"code":"Px00036012009","type":"CDM"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":41762.0,"discounted_cash":14616.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RENAL ARTERGM 1ST ORD COMP UNILAT","code_information":[{"code":"Px00036012010","type":"CDM"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":8897.0,"discounted_cash":3113.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RENAL ARTERGM 1ST ORD COMP BILAT","code_information":[{"code":"Px00036012011","type":"CDM"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":18228.0,"discounted_cash":6379.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RENAL ART 2ND/3RD ORD COMP UNILAT","code_information":[{"code":"Px00036012012","type":"CDM"},{"code":"36253","type":"HCPCS"}],"standard_charges":[{"gross_charge":8897.0,"discounted_cash":3113.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RENAL ART 2ND/3RD ORD COMP BILAT","code_information":[{"code":"Px00036012013","type":"CDM"},{"code":"36254","type":"HCPCS"}],"standard_charges":[{"gross_charge":17775.0,"discounted_cash":6221.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION IVC FILTER COMP","code_information":[{"code":"Px00036012014","type":"CDM"},{"code":"37192","type":"HCPCS"}],"standard_charges":[{"gross_charge":12986.0,"discounted_cash":4545.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC CDM","code_information":[{"code":"Px00036100010","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036100013","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2620.0,"discounted_cash":917.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OCCLUSIVE DEVICE IN VEIN ART CDM","code_information":[{"code":"Px00036100048","type":"CDM"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":723.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BYP OTH/THN VEIN FEMORAL-FEMORAL CDM","code_information":[{"code":"Px00036100075","type":"CDM"},{"code":"35661","type":"HCPCS"}],"standard_charges":[{"gross_charge":21478.0,"discounted_cash":7517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY CDM","code_information":[{"code":"Px00036100076","type":"CDM"},{"code":"33995","type":"HCPCS"}],"standard_charges":[{"gross_charge":4601.0,"discounted_cash":1610.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ CDM","code_information":[{"code":"Px00036100077","type":"CDM"},{"code":"33997","type":"HCPCS"}],"standard_charges":[{"gross_charge":4601.0,"discounted_cash":1610.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG CDM","code_information":[{"code":"Px00036100080","type":"CDM"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.0,"discounted_cash":861.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","code_information":[{"code":"Px00036100095","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC I&D ABSCESS PERITONSILLAR CDM","code_information":[{"code":"Px00036100140","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RPR/TRAUMATIC AV FISTULA EXTREMITIES","code_information":[{"code":"Px00036100142","type":"CDM"},{"code":"35190","type":"HCPCS"}],"standard_charges":[{"gross_charge":18714.0,"discounted_cash":6549.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION GASTRO TUBE CDM","code_information":[{"code":"Px00036100151","type":"CDM"},{"code":"49999","type":"HCPCS"}],"standard_charges":[{"gross_charge":4209.0,"discounted_cash":1473.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM CDM","code_information":[{"code":"Px00036100156","type":"CDM"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/OR LESS CDM","code_information":[{"code":"Px00036100157","type":"CDM"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL CARDIAC MODULJ PLS GEN CDM","code_information":[{"code":"Px00036100172","type":"CDM"},{"code":"0412T","type":"HCPCS"}],"standard_charges":[{"gross_charge":8413.0,"discounted_cash":2944.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL CAR MODULJ TRANVNS ELT CDM","code_information":[{"code":"Px00036100173","type":"CDM"},{"code":"0413T","type":"HCPCS"}],"standard_charges":[{"gross_charge":8413.0,"discounted_cash":2944.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FIBRIN SHEATHOPLASTY CDM","code_information":[{"code":"Px00036100203","type":"CDM"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.0,"discounted_cash":680.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CNTRL NOSEBLD PSTR PK/CAUT INI CDM","code_information":[{"code":"Px00036100206","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NASAL ENDOSCOPY DIAGNOSTIC UNI/BIL SPX CDM","code_information":[{"code":"Px00036100212","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ASPIRATION BLADDER BY NEEDLE CDM","code_information":[{"code":"Px00036100223","type":"CDM"},{"code":"51100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC TIB/PER ARTERY INTRA LITHO ARTHREC CDM","code_information":[{"code":"Px00036100225","type":"CDM"},{"code":"C9774","type":"HCPCS"}],"standard_charges":[{"gross_charge":57130.0,"discounted_cash":19995.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOL/THROMB BRACHIAL SUBCLAVIAN ARTERY CDM","code_information":[{"code":"Px00036100234","type":"CDM"},{"code":"34101","type":"HCPCS"}],"standard_charges":[{"gross_charge":14931.0,"discounted_cash":5225.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI FOCUSED US (MRGFUS) STEREO ABLAT INTRACRANIAL","code_information":[{"code":"Px00036100262","type":"CDM"},{"code":"61715","type":"HCPCS"}],"standard_charges":[{"gross_charge":39612.0,"discounted_cash":13864.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR TA DPLMNT BRNCHD NDGFT MULTIPIECE SYS CDM","code_information":[{"code":"Px00036100291","type":"CDM"},{"code":"33882","type":"HCPCS"}],"standard_charges":[{"gross_charge":5009.0,"discounted_cash":1753.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100293","type":"CDM"},{"code":"37254","type":"HCPCS"}],"standard_charges":[{"gross_charge":15241.0,"discounted_cash":5334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100294","type":"CDM"},{"code":"37255","type":"HCPCS"}],"standard_charges":[{"gross_charge":7621.0,"discounted_cash":2667.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100295","type":"CDM"},{"code":"37256","type":"HCPCS"}],"standard_charges":[{"gross_charge":15241.0,"discounted_cash":5334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ANGIOP UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100296","type":"CDM"},{"code":"37257","type":"HCPCS"}],"standard_charges":[{"gross_charge":7621.0,"discounted_cash":2667.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100297","type":"CDM"},{"code":"37258","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100298","type":"CDM"},{"code":"37259","type":"HCPCS"}],"standard_charges":[{"gross_charge":7431.0,"discounted_cash":2600.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100299","type":"CDM"},{"code":"37260","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IVT ST PLMT UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100300","type":"CDM"},{"code":"37261","type":"HCPCS"}],"standard_charges":[{"gross_charge":7431.0,"discounted_cash":2600.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRAVASCULAR LITHOTRIPSY IVT WITHIN SAME ARTERY CDM","code_information":[{"code":"Px00036100301","type":"CDM"},{"code":"37262","type":"HCPCS"}],"standard_charges":[{"gross_charge":25721.0,"discounted_cash":9002.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100302","type":"CDM"},{"code":"37263","type":"HCPCS"}],"standard_charges":[{"gross_charge":15241.0,"discounted_cash":5334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100303","type":"CDM"},{"code":"37264","type":"HCPCS"}],"standard_charges":[{"gross_charge":7621.0,"discounted_cash":2667.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100304","type":"CDM"},{"code":"37265","type":"HCPCS"}],"standard_charges":[{"gross_charge":15241.0,"discounted_cash":5334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ANGIOP UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100305","type":"CDM"},{"code":"37266","type":"HCPCS"}],"standard_charges":[{"gross_charge":7621.0,"discounted_cash":2667.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100306","type":"CDM"},{"code":"37267","type":"HCPCS"}],"standard_charges":[{"gross_charge":36367.0,"discounted_cash":12728.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100307","type":"CDM"},{"code":"37268","type":"HCPCS"}],"standard_charges":[{"gross_charge":18184.0,"discounted_cash":6364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100308","type":"CDM"},{"code":"37269","type":"HCPCS"}],"standard_charges":[{"gross_charge":36367.0,"discounted_cash":12728.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ST PLMT UNI CPLX LES EA ADD VSL CDM","code_information":[{"code":"Px00036100309","type":"CDM"},{"code":"37270","type":"HCPCS"}],"standard_charges":[{"gross_charge":18184.0,"discounted_cash":6364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100310","type":"CDM"},{"code":"37271","type":"HCPCS"}],"standard_charges":[{"gross_charge":36367.0,"discounted_cash":12728.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100311","type":"CDM"},{"code":"37272","type":"HCPCS"}],"standard_charges":[{"gross_charge":18184.0,"discounted_cash":6364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100312","type":"CDM"},{"code":"37273","type":"HCPCS"}],"standard_charges":[{"gross_charge":36367.0,"discounted_cash":12728.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ATHRC UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100313","type":"CDM"},{"code":"37274","type":"HCPCS"}],"standard_charges":[{"gross_charge":18184.0,"discounted_cash":6364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ST ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100314","type":"CDM"},{"code":"37275","type":"HCPCS"}],"standard_charges":[{"gross_charge":57048.0,"discounted_cash":19966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ST ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100315","type":"CDM"},{"code":"37276","type":"HCPCS"}],"standard_charges":[{"gross_charge":28524.0,"discounted_cash":9983.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC FPVT ST ATHRC UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100316","type":"CDM"},{"code":"37277","type":"HCPCS"}],"standard_charges":[{"gross_charge":57048.0,"discounted_cash":19966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVSC FPVT ST ATHRC UNI CPLX LES EA ADD VSL CDM","code_information":[{"code":"Px00036100317","type":"CDM"},{"code":"37278","type":"HCPCS"}],"standard_charges":[{"gross_charge":28524.0,"discounted_cash":9983.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRAVASCULAR LITHOTRIPSY FPVT W/IN SAME ARTERY CDM","code_information":[{"code":"Px00036100318","type":"CDM"},{"code":"37279","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100319","type":"CDM"},{"code":"37280","type":"HCPCS"}],"standard_charges":[{"gross_charge":25458.0,"discounted_cash":8910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100320","type":"CDM"},{"code":"37281","type":"HCPCS"}],"standard_charges":[{"gross_charge":12729.0,"discounted_cash":4455.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100321","type":"CDM"},{"code":"37282","type":"HCPCS"}],"standard_charges":[{"gross_charge":25458.0,"discounted_cash":8910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ANGIOP UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100322","type":"CDM"},{"code":"37283","type":"HCPCS"}],"standard_charges":[{"gross_charge":12729.0,"discounted_cash":4455.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST PLMT UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100323","type":"CDM"},{"code":"37284","type":"HCPCS"}],"standard_charges":[{"gross_charge":35463.0,"discounted_cash":12412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST PLMT UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100324","type":"CDM"},{"code":"37285","type":"HCPCS"}],"standard_charges":[{"gross_charge":17732.0,"discounted_cash":6206.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST PLMT UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100325","type":"CDM"},{"code":"37286","type":"HCPCS"}],"standard_charges":[{"gross_charge":35463.0,"discounted_cash":12412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST PLMT UNI CPLX LES EA ADD VSL CDM","code_information":[{"code":"Px00036100326","type":"CDM"},{"code":"37287","type":"HCPCS"}],"standard_charges":[{"gross_charge":17732.0,"discounted_cash":6206.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100327","type":"CDM"},{"code":"37288","type":"HCPCS"}],"standard_charges":[{"gross_charge":35463.0,"discounted_cash":12412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100328","type":"CDM"},{"code":"37289","type":"HCPCS"}],"standard_charges":[{"gross_charge":17732.0,"discounted_cash":6206.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ATHRC UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100329","type":"CDM"},{"code":"37290","type":"HCPCS"}],"standard_charges":[{"gross_charge":35463.0,"discounted_cash":12412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ATHRC UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100330","type":"CDM"},{"code":"37291","type":"HCPCS"}],"standard_charges":[{"gross_charge":17732.0,"discounted_cash":6206.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100331","type":"CDM"},{"code":"37292","type":"HCPCS"}],"standard_charges":[{"gross_charge":57048.0,"discounted_cash":19966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100332","type":"CDM"},{"code":"37293","type":"HCPCS"}],"standard_charges":[{"gross_charge":28524.0,"discounted_cash":9983.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST ATHRC UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100333","type":"CDM"},{"code":"37294","type":"HCPCS"}],"standard_charges":[{"gross_charge":57048.0,"discounted_cash":19966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVSC TPVT ST ATHRC UNI CPLX LES EA ADD VSL CDM","code_information":[{"code":"Px00036100334","type":"CDM"},{"code":"37295","type":"HCPCS"}],"standard_charges":[{"gross_charge":28524.0,"discounted_cash":9983.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IMVT ANGIOP UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100335","type":"CDM"},{"code":"37296","type":"HCPCS"}],"standard_charges":[{"gross_charge":12115.0,"discounted_cash":4240.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IMVT ANGIOP UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100336","type":"CDM"},{"code":"37297","type":"HCPCS"}],"standard_charges":[{"gross_charge":6058.0,"discounted_cash":2120.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IMVT ANGIOP UNI CPLX LES 1ST VSL CDM","code_information":[{"code":"Px00036100337","type":"CDM"},{"code":"37298","type":"HCPCS"}],"standard_charges":[{"gross_charge":12115.0,"discounted_cash":4240.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC IMVT ANGIOP UNI CPLX LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100338","type":"CDM"},{"code":"37299","type":"HCPCS"}],"standard_charges":[{"gross_charge":6058.0,"discounted_cash":2120.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABLATION IRE LIVER 1ORMORE TUMORS W/IMG GDN PERQ CDM","code_information":[{"code":"Px00036100339","type":"CDM"},{"code":"47384","type":"HCPCS"}],"standard_charges":[{"gross_charge":29672.0,"discounted_cash":10385.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ TRLUML REVSC CHRNC TOT OCCLS 1 ANTGRD&RTRGR CDM","code_information":[{"code":"Px00036100354","type":"CDM"},{"code":"92945","type":"HCPCS"}],"standard_charges":[{"gross_charge":68100.0,"discounted_cash":23835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","code_information":[{"code":"Px00036110005","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1637.0,"discounted_cash":572.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DX BONE MARROW BX & ASPIR - UNILATERAL","code_information":[{"code":"Px00036110023","type":"CDM"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":4264.0,"discounted_cash":1492.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SEL CATH PLCM 3RD ORD","code_information":[{"code":"Px00036110037","type":"CDM"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":6019.0,"discounted_cash":2106.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NASAL/OROGASTRIC W/TUBE PLMT","code_information":[{"code":"Px00036110042","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.0,"discounted_cash":408.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR","code_information":[{"code":"Px00036110070","type":"CDM"},{"code":"34813","type":"HCPCS"}],"standard_charges":[{"gross_charge":7722.0,"discounted_cash":2702.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"Px00036110071","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":392.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECT EPIDURAL PATCH","code_information":[{"code":"Px00036110072","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":365.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FRENOTOMY LINGUAL CDM","code_information":[{"code":"Px00036110073","type":"CDM"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2333.0,"discounted_cash":816.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRACHEOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110092","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW ASPIRATION","code_information":[{"code":"Px00036110101","type":"CDM"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION GASTROSTOMY TUBE","code_information":[{"code":"Px00036110104","type":"CDM"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO GASTROINTESTINAL TUBE","code_information":[{"code":"Px00036110105","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":3136.0,"discounted_cash":1097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX","code_information":[{"code":"Px00036110110","type":"CDM"},{"code":"49424","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":168.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION ABDOMINAL SHUNT","code_information":[{"code":"Px00036110111","type":"CDM"},{"code":"49427","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.0,"discounted_cash":687.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLACE GASTROSTOMY TUBE PERC","code_information":[{"code":"Px00036110112","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":13547.0,"discounted_cash":4741.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHANGE G-TUBE TO G-J PERC","code_information":[{"code":"Px00036110113","type":"CDM"},{"code":"49446","type":"HCPCS"}],"standard_charges":[{"gross_charge":6206.0,"discounted_cash":2172.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE G/C TUBE PERC","code_information":[{"code":"Px00036110114","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.0,"discounted_cash":699.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":826.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"Px00036110116","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":3136.0,"discounted_cash":1097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE","code_information":[{"code":"Px00036110117","type":"CDM"},{"code":"49460","type":"HCPCS"}],"standard_charges":[{"gross_charge":5236.0,"discounted_cash":1832.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLUORO EXAM OF G/COLON TUBE","code_information":[{"code":"Px00036110118","type":"CDM"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR URETER X-RAY THRU CATH","code_information":[{"code":"Px00036110120","type":"CDM"},{"code":"50684","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR URETER X-RAY","code_information":[{"code":"Px00036110121","type":"CDM"},{"code":"50690","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"Px00036110122","type":"CDM"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY RETROGRADE","code_information":[{"code":"Px00036110123","type":"CDM"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":116.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR MYELOGRAM","code_information":[{"code":"Px00036110126","type":"CDM"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1136.0,"discounted_cash":397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECT FOR SPINE DISK X-RAY LUMBAR","code_information":[{"code":"Px00036110127","type":"CDM"},{"code":"62290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2509.0,"discounted_cash":878.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECT FOR SPINE DISK X-RAY CERVICAL/THORACIC","code_information":[{"code":"Px00036110128","type":"CDM"},{"code":"62291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1724.0,"discounted_cash":603.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA CDM","code_information":[{"code":"Px00036110130","type":"CDM"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":5761.0,"discounted_cash":2016.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ SACRAL AUGMT BILAT INJ W/ IMG GUIDE & BONE BIOPSY","code_information":[{"code":"Px00036110137","type":"CDM"},{"code":"0201T","type":"HCPCS"}],"standard_charges":[{"gross_charge":26980.0,"discounted_cash":9443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC ILIAC ART","code_information":[{"code":"Px00036110142","type":"CDM"},{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"gross_charge":19715.0,"discounted_cash":6900.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC NEEDLE BIOPSY CHEST LINING","code_information":[{"code":"Px00036110158","type":"CDM"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":1694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT PLEURAL CATH","code_information":[{"code":"Px00036110166","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":13209.0,"discounted_cash":4623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN INIT DAY","code_information":[{"code":"Px00036110167","type":"CDM"},{"code":"32561","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN SUBQ DAY","code_information":[{"code":"Px00036110168","type":"CDM"},{"code":"32562","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART PACEMAKER","code_information":[{"code":"Px00036110169","type":"CDM"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":15926.0,"discounted_cash":5574.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION PERM HEART PACEMAKER","code_information":[{"code":"Px00036110170","type":"CDM"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":16331.0,"discounted_cash":5715.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION PERM AV PACER","code_information":[{"code":"Px00036110171","type":"CDM"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":16331.0,"discounted_cash":5715.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART ELECTRODE 33210","code_information":[{"code":"Px00036110172","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":21529.0,"discounted_cash":7535.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF PULSE GENERATOR","code_information":[{"code":"Px00036110175","type":"CDM"},{"code":"33212","type":"HCPCS"}],"standard_charges":[{"gross_charge":15926.0,"discounted_cash":5574.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE DUAL CHAMBER PACER","code_information":[{"code":"Px00036110176","type":"CDM"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":15926.0,"discounted_cash":5574.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC UPGRADE OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110178","type":"CDM"},{"code":"33214","type":"HCPCS"}],"standard_charges":[{"gross_charge":24315.0,"discounted_cash":8510.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION PACING-IMPLANTABLE DEFIB LEAD","code_information":[{"code":"Px00036110179","type":"CDM"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT 1 ELECTRODE PM-IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110180","type":"CDM"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT 2 ELECTRODE PM-IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110181","type":"CDM"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR LEAD PACE- IMPLANTABLE DEFIB ONE","code_information":[{"code":"Px00036110182","type":"CDM"},{"code":"33218","type":"HCPCS"}],"standard_charges":[{"gross_charge":9996.0,"discounted_cash":3498.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR LEAD PACE-IMPLANTABLE DEFIB DUAL","code_information":[{"code":"Px00036110183","type":"CDM"},{"code":"33220","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RELOCATION POCKET PACEMAKER","code_information":[{"code":"Px00036110184","type":"CDM"},{"code":"33222","type":"HCPCS"}],"standard_charges":[{"gross_charge":8381.0,"discounted_cash":2933.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RELOCATE POCKET FOR IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110185","type":"CDM"},{"code":"33223","type":"HCPCS"}],"standard_charges":[{"gross_charge":8595.0,"discounted_cash":3008.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT PACING LEAD & CONNECT","code_information":[{"code":"Px00036110186","type":"CDM"},{"code":"33224","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L VENTRIC PACING LEAD ADD-ON","code_information":[{"code":"Px00036110187","type":"CDM"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":9996.0,"discounted_cash":3498.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION L VENTRIC LEAD","code_information":[{"code":"Px00036110188","type":"CDM"},{"code":"33226","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110189","type":"CDM"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":8603.0,"discounted_cash":3011.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE PACER PERM SINGLE LEAD","code_information":[{"code":"Px00036110191","type":"CDM"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PACEMAKER ELECTRODE","code_information":[{"code":"Px00036110192","type":"CDM"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":9996.0,"discounted_cash":3498.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT PULSE GENERATOR","code_information":[{"code":"Px00036110193","type":"CDM"},{"code":"33240","type":"HCPCS"}],"standard_charges":[{"gross_charge":25228.0,"discounted_cash":8829.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE PULSE GENERATOR","code_information":[{"code":"Px00036110194","type":"CDM"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":8391.0,"discounted_cash":2936.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE ELTRD TRANSVEN","code_information":[{"code":"Px00036110195","type":"CDM"},{"code":"33244","type":"HCPCS"}],"standard_charges":[{"gross_charge":13840.0,"discounted_cash":4844.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ELTRD/INSERT PACE-DEFIB","code_information":[{"code":"Px00036110196","type":"CDM"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":25872.0,"discounted_cash":9055.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC TAA REPR INCL SUBCL","code_information":[{"code":"Px00036110200","type":"CDM"},{"code":"33880","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":1911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOL/THROMBECTOMY FEMPOP AORTOILIAC ART","code_information":[{"code":"Px00036110202","type":"CDM"},{"code":"34201","type":"HCPCS"}],"standard_charges":[{"gross_charge":25987.0,"discounted_cash":9095.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TEAEC W/WO PATCH GRAFT COMMON FEMORAL","code_information":[{"code":"Px00036110203","type":"CDM"},{"code":"35371","type":"HCPCS"}],"standard_charges":[{"gross_charge":22200.0,"discounted_cash":7770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE","code_information":[{"code":"Px00036110217","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL","code_information":[{"code":"Px00036110231","type":"CDM"},{"code":"63655","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":319.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION","code_information":[{"code":"Px00036110239","type":"CDM"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1026.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL","code_information":[{"code":"Px00036110240","type":"CDM"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL","code_information":[{"code":"Px00036110242","type":"CDM"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1466.0,"discounted_cash":513.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION","code_information":[{"code":"Px00036110244","type":"CDM"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":4539.0,"discounted_cash":1588.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL","code_information":[{"code":"Px00036110245","type":"CDM"},{"code":"10010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2269.0,"discounted_cash":794.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110248","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110249","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110250","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":460.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110251","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110252","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":542.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX PX KNEE ARTHG OR CNTRST ENHNCD CT/MRI KNEE","code_information":[{"code":"Px00036110253","type":"CDM"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":431.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG","code_information":[{"code":"Px00036110254","type":"CDM"},{"code":"33274","type":"HCPCS"}],"standard_charges":[{"gross_charge":96321.0,"discounted_cash":33712.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HTCAT REMOVAL PERM LEADLESS PACEMAKER R VENTR","code_information":[{"code":"Px00036110255","type":"CDM"},{"code":"33275","type":"HCPCS"}],"standard_charges":[{"gross_charge":14617.0,"discounted_cash":5115.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG","code_information":[{"code":"Px00036110256","type":"CDM"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":10611.0,"discounted_cash":3713.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR","code_information":[{"code":"Px00036110257","type":"CDM"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":8603.0,"discounted_cash":3011.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT PICC WO PORT PUMP LT 5 YR W IMG","code_information":[{"code":"Px00036110259","type":"CDM"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1674.0,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"Px00036110260","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6956.0,"discounted_cash":2434.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110283","type":"CDM"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":271.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS WHITE BLOOD CELLS CDM","code_information":[{"code":"Px00036110291","type":"CDM"},{"code":"36511","type":"HCPCS"}],"standard_charges":[{"gross_charge":5981.0,"discounted_cash":2093.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLATELETS CDM","code_information":[{"code":"Px00036110292","type":"CDM"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":6579.0,"discounted_cash":2302.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVASC TAA REPR W/O SUBCL","code_information":[{"code":"Px00036110362","type":"CDM"},{"code":"33881","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":1911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE AORTIC ASSIST DEVICE","code_information":[{"code":"Px00036110367","type":"CDM"},{"code":"33968","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":666.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVAS ILIAC A DEVICE ADDON","code_information":[{"code":"Px00036110376","type":"CDM"},{"code":"34808","type":"HCPCS"}],"standard_charges":[{"gross_charge":7722.0,"discounted_cash":2702.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XPOSE FOR ENDOPROSTH FEMORL","code_information":[{"code":"Px00036110377","type":"CDM"},{"code":"34812","type":"HCPCS"}],"standard_charges":[{"gross_charge":15442.0,"discounted_cash":5404.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PSEUDOANEURYSM INJECTION TRT","code_information":[{"code":"Px00036110385","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"discounted_cash":499.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION EXT VENOGRAPHY","code_information":[{"code":"Px00036110386","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":325.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN VEIN","code_information":[{"code":"Px00036110388","type":"CDM"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2874.0,"discounted_cash":1005.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VENOUS PLACEMENT 1ST ORDER","code_information":[{"code":"Px00036110389","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":4224.0,"discounted_cash":1478.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCT CATH 2ND VENOUS","code_information":[{"code":"Px00036110390","type":"CDM"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":4332.0,"discounted_cash":1516.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN HEART/PULM ARTERY","code_information":[{"code":"Px00036110391","type":"CDM"},{"code":"36013","type":"HCPCS"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":2207.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RT/LT PULMONARY PLACEMENT","code_information":[{"code":"Px00036110392","type":"CDM"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":2207.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SELECT SEGMENTAL PULMONARY ART","code_information":[{"code":"Px00036110393","type":"CDM"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":2207.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO CATH EXTRM ART","code_information":[{"code":"Px00036110397","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2669.0,"discounted_cash":934.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE","code_information":[{"code":"Px00036110398","type":"CDM"},{"code":"61107","type":"HCPCS"}],"standard_charges":[{"gross_charge":6980.0,"discounted_cash":2443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN AORTA","code_information":[{"code":"Px00036110402","type":"CDM"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2874.0,"discounted_cash":1005.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN THOR/BRA ARTERY","code_information":[{"code":"Px00036110403","type":"CDM"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110404","type":"CDM"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO ADDT","code_information":[{"code":"Px00036110406","type":"CDM"},{"code":"36218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 1ST ORDER","code_information":[{"code":"Px00036110408","type":"CDM"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":4378.0,"discounted_cash":1532.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110409","type":"CDM"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 3RD ORDER","code_information":[{"code":"Px00036110410","type":"CDM"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO ADDT","code_information":[{"code":"Px00036110411","type":"CDM"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":190.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF CATHETER VEIN","code_information":[{"code":"Px00036110416","type":"CDM"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":2305.0,"discounted_cash":806.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF CATHETER VEIN FOR SAMPLING","code_information":[{"code":"Px00036110417","type":"CDM"},{"code":"36500","type":"HCPCS"}],"standard_charges":[{"gross_charge":4005.0,"discounted_cash":1401.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT NON TUNNEL CV CATH GTE 5 YR","code_information":[{"code":"Px00036110418","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":6927.0,"discounted_cash":2424.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CVC W/O SQ PORT/PMP/YOUNGER THAN 5 YRS","code_information":[{"code":"Px00036110424","type":"CDM"},{"code":"36557","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CV CATH > 5","code_information":[{"code":"Px00036110425","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":18125.0,"discounted_cash":6343.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ TUNNELED CTR VAD W/SUBQ PORT YOUNGER THAN 5 YRS","code_information":[{"code":"Px00036110426","type":"CDM"},{"code":"36560","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CV CATH W/PORT > 5","code_information":[{"code":"Px00036110427","type":"CDM"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CV CATH W/SUBC PUMP","code_information":[{"code":"Px00036110429","type":"CDM"},{"code":"36563","type":"HCPCS"}],"standard_charges":[{"gross_charge":29849.0,"discounted_cash":10447.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS TNELD CV ACCES DVCE W/2CATHS","code_information":[{"code":"Px00036110430","type":"CDM"},{"code":"36565","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT PICC WO PORT PUMP LT 5 YR","code_information":[{"code":"Px00036110431","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC WO IMG GDN GTE 5 YR","code_information":[{"code":"Px00036110432","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR TUNNELED CV CATH","code_information":[{"code":"Px00036110437","type":"CDM"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1674.0,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR TUNNELED CV CATH W/PUMP OR PORT","code_information":[{"code":"Px00036110438","type":"CDM"},{"code":"36576","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE NON TUNNEL CVAD CATH","code_information":[{"code":"Px00036110440","type":"CDM"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE TUNNELED CV CATH W/O PUMP","code_information":[{"code":"Px00036110441","type":"CDM"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE TUNNELED CV ACCESS DEVICE","code_information":[{"code":"Px00036110442","type":"CDM"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPLETE REPLACEMENT PICC RS&I","code_information":[{"code":"Px00036110443","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":5377.0,"discounted_cash":1881.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE PICVAD CATH","code_information":[{"code":"Px00036110444","type":"CDM"},{"code":"36585","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE TUNNEL CV CATH WO PORT PUMP","code_information":[{"code":"Px00036110445","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3801.0,"discounted_cash":1330.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00036110446","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":9944.0,"discounted_cash":3480.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL TUNNELED CV CATH W/PORT OR PUMP","code_information":[{"code":"Px00036110449","type":"CDM"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":6922.0,"discounted_cash":2422.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MECH REMOV TUNNELED CV CATH","code_information":[{"code":"Px00036110452","type":"CDM"},{"code":"36595","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MECH REMOV TUNNELED CV CATH THRU DEVICE LUMEN","code_information":[{"code":"Px00036110453","type":"CDM"},{"code":"36596","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION VENOUS CATHETER","code_information":[{"code":"Px00036110454","type":"CDM"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":6620.0,"discounted_cash":2317.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ W/FLUOR EVAL CV DEVICE","code_information":[{"code":"Px00036110455","type":"CDM"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.0,"discounted_cash":718.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","code_information":[{"code":"Px00036110456","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00036110457","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1358.0,"discounted_cash":475.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOL/THROMB POPLIT-TIB-PERON ARTERY LEG","code_information":[{"code":"Px00036110460","type":"CDM"},{"code":"34203","type":"HCPCS"}],"standard_charges":[{"gross_charge":19579.0,"discounted_cash":6852.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00036110462","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":10100.0,"discounted_cash":3535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT CATH UMBILICAL ARTERY NEWBORN CDM","code_information":[{"code":"Px00036110463","type":"CDM"},{"code":"36660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"discounted_cash":658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00036110465","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":12122.0,"discounted_cash":4242.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT HEPATIC SHUNT (TIPS)","code_information":[{"code":"Px00036110474","type":"CDM"},{"code":"37182","type":"HCPCS"}],"standard_charges":[{"gross_charge":16534.0,"discounted_cash":5786.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVISE HEPATIC SHUNT TIPS","code_information":[{"code":"Px00036110475","type":"CDM"},{"code":"37183","type":"HCPCS"}],"standard_charges":[{"gross_charge":16534.0,"discounted_cash":5786.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRIM ART MECH THROMBECTOMY","code_information":[{"code":"Px00036110476","type":"CDM"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":31661.0,"discounted_cash":11081.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRIM ART M-THROMBECT ADD-ON","code_information":[{"code":"Px00036110477","type":"CDM"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":31661.0,"discounted_cash":11081.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SEC ART M-THROMBECT ADD-ON","code_information":[{"code":"Px00036110478","type":"CDM"},{"code":"37186","type":"HCPCS"}],"standard_charges":[{"gross_charge":31661.0,"discounted_cash":11081.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VENOUS MECH THROMBECTOMY","code_information":[{"code":"Px00036110479","type":"CDM"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":32469.0,"discounted_cash":11364.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VENOUS M-THROMBECTOMY ADD-ON","code_information":[{"code":"Px00036110480","type":"CDM"},{"code":"37188","type":"HCPCS"}],"standard_charges":[{"gross_charge":31661.0,"discounted_cash":11081.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYTIC THERAPY STROKE","code_information":[{"code":"Px00036110481","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.0,"discounted_cash":463.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATHETER BIOPSY","code_information":[{"code":"Px00036110482","type":"CDM"},{"code":"37200","type":"HCPCS"}],"standard_charges":[{"gross_charge":34270.0,"discounted_cash":11994.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH STENT CCA W/EPS","code_information":[{"code":"Px00036110493","type":"CDM"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":35904.0,"discounted_cash":12566.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH STENT CCA W/O EPS","code_information":[{"code":"Px00036110494","type":"CDM"},{"code":"37216","type":"HCPCS"}],"standard_charges":[{"gross_charge":35179.0,"discounted_cash":12312.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC","code_information":[{"code":"Px00036110495","type":"CDM"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":15241.0,"discounted_cash":5334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC W/STENT","code_information":[{"code":"Px00036110496","type":"CDM"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":14862.0,"discounted_cash":5201.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC ADD-ON","code_information":[{"code":"Px00036110497","type":"CDM"},{"code":"37222","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.0,"discounted_cash":2555.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC W/STENT ADD-ON","code_information":[{"code":"Px00036110498","type":"CDM"},{"code":"37223","type":"HCPCS"}],"standard_charges":[{"gross_charge":11153.0,"discounted_cash":3903.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVAS W/TLA","code_information":[{"code":"Px00036110499","type":"CDM"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":15241.0,"discounted_cash":5334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVAS W/ATHER","code_information":[{"code":"Px00036110500","type":"CDM"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":36367.0,"discounted_cash":12728.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS RED BLOOD CELLS CDM","code_information":[{"code":"Px00036110501","type":"CDM"},{"code":"36512","type":"HCPCS"}],"standard_charges":[{"gross_charge":6579.0,"discounted_cash":2302.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVASC W/STENT","code_information":[{"code":"Px00036110502","type":"CDM"},{"code":"37226","type":"HCPCS"}],"standard_charges":[{"gross_charge":36367.0,"discounted_cash":12728.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVASC STNT & ATHER","code_information":[{"code":"Px00036110503","type":"CDM"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":57048.0,"discounted_cash":19966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/TLA","code_information":[{"code":"Px00036110504","type":"CDM"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":25458.0,"discounted_cash":8910.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/ATHER","code_information":[{"code":"Px00036110505","type":"CDM"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":35463.0,"discounted_cash":12412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/STENT","code_information":[{"code":"Px00036110506","type":"CDM"},{"code":"37230","type":"HCPCS"}],"standard_charges":[{"gross_charge":35463.0,"discounted_cash":12412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC STENT & ATHER","code_information":[{"code":"Px00036110507","type":"CDM"},{"code":"37231","type":"HCPCS"}],"standard_charges":[{"gross_charge":57048.0,"discounted_cash":19966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC ADD-ON","code_information":[{"code":"Px00036110508","type":"CDM"},{"code":"37232","type":"HCPCS"}],"standard_charges":[{"gross_charge":7488.0,"discounted_cash":2620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIBPER REVASC W/ATHER ADD-ON","code_information":[{"code":"Px00036110509","type":"CDM"},{"code":"37233","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.0,"discounted_cash":2555.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVSC OPN/PRQ TIB/PERO STENT","code_information":[{"code":"Px00036110510","type":"CDM"},{"code":"37234","type":"HCPCS"}],"standard_charges":[{"gross_charge":11153.0,"discounted_cash":3903.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC STNT & ATHER","code_information":[{"code":"Px00036110511","type":"CDM"},{"code":"37235","type":"HCPCS"}],"standard_charges":[{"gross_charge":11153.0,"discounted_cash":3903.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LARYNGOSCOPY FLEXIBLE DIAGNOSTIC","code_information":[{"code":"Px00036110516","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI CDM","code_information":[{"code":"Px00036110523","type":"CDM"},{"code":"34717","type":"HCPCS"}],"standard_charges":[{"gross_charge":10836.0,"discounted_cash":3792.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI CDM","code_information":[{"code":"Px00036110524","type":"CDM"},{"code":"34718","type":"HCPCS"}],"standard_charges":[{"gross_charge":16267.0,"discounted_cash":5693.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG CDM","code_information":[{"code":"Px00036110530","type":"CDM"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3737.0,"discounted_cash":1307.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN CDM","code_information":[{"code":"Px00036110531","type":"CDM"},{"code":"64625","type":"HCPCS"}],"standard_charges":[{"gross_charge":8074.0,"discounted_cash":2825.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT CDM","code_information":[{"code":"Px00036110536","type":"CDM"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3418.0,"discounted_cash":1196.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT NON TUNNEL CV CATH LT 5 YR","code_information":[{"code":"Px00036110537","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":12046.0,"discounted_cash":4216.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE SUPERFICIAL","code_information":[{"code":"Px00036110558","type":"CDM"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2639.0,"discounted_cash":923.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION OF SINUS TRACT","code_information":[{"code":"Px00036110559","type":"CDM"},{"code":"20500","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1169.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","code_information":[{"code":"Px00036110562","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABLATE BONE TUMOR(S) PERQ W/GUIDE RF ABLATION","code_information":[{"code":"Px00036110564","type":"CDM"},{"code":"20982","type":"HCPCS"}],"standard_charges":[{"gross_charge":20997.0,"discounted_cash":7348.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF NECK/CHEST - SOFT TISSUE","code_information":[{"code":"Px00036110567","type":"CDM"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5608.0,"discounted_cash":1962.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT CDM","code_information":[{"code":"Px00036110570","type":"CDM"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":3418.0,"discounted_cash":1196.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG CDM","code_information":[{"code":"Px00036110578","type":"CDM"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"discounted_cash":838.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110585","type":"CDM"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":24268.0,"discounted_cash":8493.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110586","type":"CDM"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":12986.0,"discounted_cash":4545.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG CDM","code_information":[{"code":"Px00036110587","type":"CDM"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"discounted_cash":838.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"Px00036110601","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","code_information":[{"code":"Px00036110602","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS","code_information":[{"code":"Px00036110604","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS","code_information":[{"code":"Px00036110605","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR SUPERFICIAL WOUND(S) 2.5 TO 7.5 CM","code_information":[{"code":"Px00036110606","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY MUSCLE PERCUTANEOUS NEEDLE CDM","code_information":[{"code":"Px00036110610","type":"CDM"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"Px00036110611","type":"CDM"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2693.0,"discounted_cash":942.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA INTERMED","code_information":[{"code":"Px00036110614","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00036110619","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2152.0,"discounted_cash":753.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"Px00036110622","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":4425.0,"discounted_cash":1548.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE LUNG CATHETER","code_information":[{"code":"Px00036110623","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2653.0,"discounted_cash":928.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL OF CLOT IN GRAFT","code_information":[{"code":"Px00036110640","type":"CDM"},{"code":"35875","type":"HCPCS"}],"standard_charges":[{"gross_charge":18241.0,"discounted_cash":6384.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRODUCTION NEEDLE/INTRACATHETER VEIN","code_information":[{"code":"Px00036110641","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION THERAPY OF VEIN","code_information":[{"code":"Px00036110642","type":"CDM"},{"code":"36470","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SPLEEN X-RAY","code_information":[{"code":"Px00036110643","type":"CDM"},{"code":"38200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3583.0,"discounted_cash":1254.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00036110646","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC DILATION BILIARY W/O STENT","code_information":[{"code":"Px00036110656","type":"CDM"},{"code":"47555","type":"HCPCS"}],"standard_charges":[{"gross_charge":8915.0,"discounted_cash":3120.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC DILATION BILIARY W/ STENT","code_information":[{"code":"Px00036110657","type":"CDM"},{"code":"47556","type":"HCPCS"}],"standard_charges":[{"gross_charge":8681.0,"discounted_cash":3038.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY PANCREAS","code_information":[{"code":"Px00036110659","type":"CDM"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":12585.0,"discounted_cash":4404.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036110662","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":4435.0,"discounted_cash":1552.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY ABDOMINAL MASS","code_information":[{"code":"Px00036110664","type":"CDM"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LAP INSERT TUNNEL IP CATH","code_information":[{"code":"Px00036110665","type":"CDM"},{"code":"49324","type":"HCPCS"}],"standard_charges":[{"gross_charge":24222.0,"discounted_cash":8477.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AIR INJECTION INTO ABDOMEN","code_information":[{"code":"Px00036110666","type":"CDM"},{"code":"49400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1616.0,"discounted_cash":565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUN INTRAPERITONEAL CATH PERC","code_information":[{"code":"Px00036110667","type":"CDM"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":10467.0,"discounted_cash":3663.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT TUN IP CATH W/PORT","code_information":[{"code":"Px00036110668","type":"CDM"},{"code":"49419","type":"HCPCS"}],"standard_charges":[{"gross_charge":10467.0,"discounted_cash":3663.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS TUN IP CATH FOR DIAL OPN","code_information":[{"code":"Px00036110669","type":"CDM"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":19192.0,"discounted_cash":6717.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE TUNNELED IP CATH","code_information":[{"code":"Px00036110670","type":"CDM"},{"code":"49422","type":"HCPCS"}],"standard_charges":[{"gross_charge":7069.0,"discounted_cash":2474.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE DRAINAGE CATHETER","code_information":[{"code":"Px00036110671","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":17120.0,"discounted_cash":5992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RENAL BIOPSY PERQ","code_information":[{"code":"Px00036110673","type":"CDM"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF KIDNEY LESION","code_information":[{"code":"Px00036110677","type":"CDM"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN BLADDER W/CATH INSERTION","code_information":[{"code":"Px00036110683","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":4421.0,"discounted_cash":1547.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYSTOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110687","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHANGE OF BLADDER TUBE","code_information":[{"code":"Px00036110688","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"discounted_cash":846.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DILATE URETHRA STRICTURE","code_information":[{"code":"Px00036110691","type":"CDM"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX","code_information":[{"code":"Px00036110696","type":"CDM"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2249.0,"discounted_cash":787.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH OCCLUSION CNS","code_information":[{"code":"Px00036110698","type":"CDM"},{"code":"61624","type":"HCPCS"}],"standard_charges":[{"gross_charge":29524.0,"discounted_cash":10333.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH OCCLUSION NON-CNS","code_information":[{"code":"Px00036110699","type":"CDM"},{"code":"61626","type":"HCPCS"}],"standard_charges":[{"gross_charge":54859.0,"discounted_cash":19200.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTERDISCAL PERQ ASPIR DX","code_information":[{"code":"Px00036110700","type":"CDM"},{"code":"62267","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN CEREBRO SPINAL FLUID","code_information":[{"code":"Px00036110702","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2587.0,"discounted_cash":905.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC N BLOCK OTHER PERIPHERAL","code_information":[{"code":"Px00036110718","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1569.0,"discounted_cash":549.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT C/T 1 LEV","code_information":[{"code":"Px00036110723","type":"CDM"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":9107.0,"discounted_cash":3187.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT C/T 2 LEV","code_information":[{"code":"Px00036110725","type":"CDM"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":1594.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT L/S 1 LEV","code_information":[{"code":"Px00036110728","type":"CDM"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":9107.0,"discounted_cash":3187.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT L/S 2 LEV","code_information":[{"code":"Px00036110730","type":"CDM"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":1594.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT L/S 3 LEV","code_information":[{"code":"Px00036110732","type":"CDM"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":1594.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC N BLOCK LUMBAR/THORACIC","code_information":[{"code":"Px00036110733","type":"CDM"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2639.0,"discounted_cash":923.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC N BLOCK INJ CELIAC PLEXUS","code_information":[{"code":"Px00036110734","type":"CDM"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3083.0,"discounted_cash":1079.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NON HOSP DELIVERY EPISIOTOMY/VAG REPAIR CDM","code_information":[{"code":"Px00036110737","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":11815.0,"discounted_cash":4135.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS","code_information":[{"code":"Px00036110782","type":"CDM"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":3283.0,"discounted_cash":1149.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ MAJOR JOINT - SHOULDER/HIP/KNEE","code_information":[{"code":"Px00036110812","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DCMPRN FASCT LEG ANT&/LAT&PST CMPRT","code_information":[{"code":"Px00036110893","type":"CDM"},{"code":"27602","type":"HCPCS"}],"standard_charges":[{"gross_charge":10306.0,"discounted_cash":3607.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TREAT PLEURODESIS W/AGENT","code_information":[{"code":"Px00036110912","type":"CDM"},{"code":"32560","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":326.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC RADIO FREQ ABLATION PULMONARY TUMOR","code_information":[{"code":"Px00036110913","type":"CDM"},{"code":"32998","type":"HCPCS"}],"standard_charges":[{"gross_charge":36150.0,"discounted_cash":12652.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE LYMPH NODE LESION","code_information":[{"code":"Px00036110932","type":"CDM"},{"code":"38300","type":"HCPCS"}],"standard_charges":[{"gross_charge":9908.0,"discounted_cash":3467.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"Px00036110934","type":"CDM"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC RADIO FREQ ABLATION LIVER TUMOR","code_information":[{"code":"Px00036110946","type":"CDM"},{"code":"47382","type":"HCPCS"}],"standard_charges":[{"gross_charge":36150.0,"discounted_cash":12652.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC APHERESIS PLASMA PHERESIS CDM","code_information":[{"code":"Px00036110977","type":"CDM"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":5981.0,"discounted_cash":2093.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SWAN GANZ INSERTION/PLACEMENT","code_information":[{"code":"Px00036110992","type":"CDM"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.0,"discounted_cash":1851.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MEASURE KIDNEY PRESSURE","code_information":[{"code":"Px00036111007","type":"CDM"},{"code":"50396","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":497.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC RADIO FREQ ABLATION RENAL TUMOR","code_information":[{"code":"Px00036111013","type":"CDM"},{"code":"50592","type":"HCPCS"}],"standard_charges":[{"gross_charge":19714.0,"discounted_cash":6899.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERC CRYO ABLATION RENAL TUMOR","code_information":[{"code":"Px00036111014","type":"CDM"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":19714.0,"discounted_cash":6899.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHANGE OF URETER TUBE/STENT","code_information":[{"code":"Px00036111015","type":"CDM"},{"code":"50688","type":"HCPCS"}],"standard_charges":[{"gross_charge":4421.0,"discounted_cash":1547.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANAL/URINARY MUSCLE STUDY, W/ NEEDLE","code_information":[{"code":"Px00036111022","type":"CDM"},{"code":"51785","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.0,"discounted_cash":405.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CYSTOURETHROSCOPY, W/ INSERTION OF INDWELLING URETERAL STENT","code_information":[{"code":"Px00036111025","type":"CDM"},{"code":"52332","type":"HCPCS"}],"standard_charges":[{"gross_charge":8615.0,"discounted_cash":3015.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION INTO BRAIN CANAL FOR DIAGNOSIS/TREATMENT","code_information":[{"code":"Px00036111040","type":"CDM"},{"code":"61026","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRACRANIAL ANGIOPLASTY","code_information":[{"code":"Px00036111048","type":"CDM"},{"code":"61630","type":"HCPCS"}],"standard_charges":[{"gross_charge":26174.0,"discounted_cash":9160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRACRANIAL ANGIOPLASTY W/STENT","code_information":[{"code":"Px00036111049","type":"CDM"},{"code":"61635","type":"HCPCS"}],"standard_charges":[{"gross_charge":26841.0,"discounted_cash":9394.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DILATE INTRACRANIAL VASOSPASM INITIAL","code_information":[{"code":"Px00036111050","type":"CDM"},{"code":"61640","type":"HCPCS"}],"standard_charges":[{"gross_charge":26174.0,"discounted_cash":9160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ BALO DILA IC VSPSM EA VSL SM VASC TER","code_information":[{"code":"Px00036111051","type":"CDM"},{"code":"61641","type":"HCPCS"}],"standard_charges":[{"gross_charge":26174.0,"discounted_cash":9160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ BALO DILA IC VSPSM EA VSL DIFF VASC TER","code_information":[{"code":"Px00036111052","type":"CDM"},{"code":"61642","type":"HCPCS"}],"standard_charges":[{"gross_charge":26174.0,"discounted_cash":9160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN CDM","code_information":[{"code":"Px00036111069","type":"CDM"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2034.0,"discounted_cash":711.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL","code_information":[{"code":"Px00036111071","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2639.0,"discounted_cash":923.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX CDM","code_information":[{"code":"Px00036111077","type":"CDM"},{"code":"61020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3254.0,"discounted_cash":1138.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE CDM","code_information":[{"code":"Px00036111081","type":"CDM"},{"code":"61210","type":"HCPCS"}],"standard_charges":[{"gross_charge":6980.0,"discounted_cash":2443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION THERAPEUTIC CARPAL TUNNEL CDM","code_information":[{"code":"Px00036111082","type":"CDM"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DELIVERY PLACENTA SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00036111084","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":5943.0,"discounted_cash":2080.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE CDM","code_information":[{"code":"Px00036111093","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":482.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS TEMP INDWELLING BLADDER CATH COMPLICATED CDM","code_information":[{"code":"Px00036111105","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT/REDO SPINE NERVE GENERATOR","code_information":[{"code":"Px00036111112","type":"CDM"},{"code":"63685","type":"HCPCS"}],"standard_charges":[{"gross_charge":74540.0,"discounted_cash":26089.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","code_information":[{"code":"Px00036111116","type":"CDM"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":14350.0,"discounted_cash":5022.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","code_information":[{"code":"Px00036111117","type":"CDM"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":7180.0,"discounted_cash":2513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","code_information":[{"code":"Px00036111124","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":500.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","code_information":[{"code":"Px00036111125","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2383.0,"discounted_cash":834.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","code_information":[{"code":"Px00036111126","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":992.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","code_information":[{"code":"Px00036111127","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":1041.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","code_information":[{"code":"Px00036111129","type":"CDM"},{"code":"36221","type":"HCPCS"}],"standard_charges":[{"gross_charge":10577.0,"discounted_cash":3701.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","code_information":[{"code":"Px00036111130","type":"CDM"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":19505.0,"discounted_cash":6826.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","code_information":[{"code":"Px00036111131","type":"CDM"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":26457.0,"discounted_cash":9259.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","code_information":[{"code":"Px00036111132","type":"CDM"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":29264.0,"discounted_cash":10242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"Px00036111133","type":"CDM"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":18984.0,"discounted_cash":6644.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"Px00036111134","type":"CDM"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":20386.0,"discounted_cash":7135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","code_information":[{"code":"Px00036111135","type":"CDM"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":6353.0,"discounted_cash":2223.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","code_information":[{"code":"Px00036111136","type":"CDM"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":5099.0,"discounted_cash":1784.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS ARTERIAL INFUSION W/IMAGING INIT TX","code_information":[{"code":"Px00036111138","type":"CDM"},{"code":"37211","type":"HCPCS"}],"standard_charges":[{"gross_charge":22542.0,"discounted_cash":7889.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","code_information":[{"code":"Px00036111139","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":12496.0,"discounted_cash":4373.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL","code_information":[{"code":"Px00036111141","type":"CDM"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":13295.0,"discounted_cash":4653.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH","code_information":[{"code":"Px00036111142","type":"CDM"},{"code":"33361","type":"HCPCS"}],"standard_charges":[{"gross_charge":69896.0,"discounted_cash":24463.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH","code_information":[{"code":"Px00036111143","type":"CDM"},{"code":"33362","type":"HCPCS"}],"standard_charges":[{"gross_charge":68160.0,"discounted_cash":23856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH","code_information":[{"code":"Px00036111144","type":"CDM"},{"code":"33363","type":"HCPCS"}],"standard_charges":[{"gross_charge":69896.0,"discounted_cash":24463.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH","code_information":[{"code":"Px00036111145","type":"CDM"},{"code":"33364","type":"HCPCS"}],"standard_charges":[{"gross_charge":68160.0,"discounted_cash":23856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH","code_information":[{"code":"Px00036111146","type":"CDM"},{"code":"33365","type":"HCPCS"}],"standard_charges":[{"gross_charge":66531.0,"discounted_cash":23285.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH","code_information":[{"code":"Px00036111147","type":"CDM"},{"code":"33367","type":"HCPCS"}],"standard_charges":[{"gross_charge":11999.0,"discounted_cash":4199.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH","code_information":[{"code":"Px00036111148","type":"CDM"},{"code":"33368","type":"HCPCS"}],"standard_charges":[{"gross_charge":11999.0,"discounted_cash":4199.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH","code_information":[{"code":"Px00036111149","type":"CDM"},{"code":"33369","type":"HCPCS"}],"standard_charges":[{"gross_charge":11999.0,"discounted_cash":4199.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","code_information":[{"code":"Px00036111150","type":"CDM"},{"code":"33990","type":"HCPCS"}],"standard_charges":[{"gross_charge":5426.0,"discounted_cash":1899.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION","code_information":[{"code":"Px00036111152","type":"CDM"},{"code":"33992","type":"HCPCS"}],"standard_charges":[{"gross_charge":5426.0,"discounted_cash":1899.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOSITION VAD W/IMAGING DIFFERENT SESSION","code_information":[{"code":"Px00036111153","type":"CDM"},{"code":"33993","type":"HCPCS"}],"standard_charges":[{"gross_charge":2647.0,"discounted_cash":926.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE BLOCK INJ PUDENDAL","code_information":[{"code":"Px00036111164","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3083.0,"discounted_cash":1079.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT CATH UMBILICAL VEIN NEWBORN CDM","code_information":[{"code":"Px00036111172","type":"CDM"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"discounted_cash":658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GUIDE CATH FLUID DRAINAGE SOFT TISSUE","code_information":[{"code":"Px00036111182","type":"CDM"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2437.0,"discounted_cash":852.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION STEREO","code_information":[{"code":"Px00036111183","type":"CDM"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":11821.0,"discounted_cash":4137.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION STEREO","code_information":[{"code":"Px00036111184","type":"CDM"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.0,"discounted_cash":1851.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION US IMAG","code_information":[{"code":"Px00036111185","type":"CDM"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":8789.0,"discounted_cash":3076.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION US IMAG","code_information":[{"code":"Px00036111186","type":"CDM"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":4866.0,"discounted_cash":1703.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION MR IMAG","code_information":[{"code":"Px00036111187","type":"CDM"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":11040.0,"discounted_cash":3864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION MR IMAG","code_information":[{"code":"Px00036111188","type":"CDM"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":1932.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEVICE LOC BREAST 1ST IMAG","code_information":[{"code":"Px00036111189","type":"CDM"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":3636.0,"discounted_cash":1272.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEVICE LOC BREAST EA IMAG","code_information":[{"code":"Px00036111190","type":"CDM"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.0,"discounted_cash":637.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST 1ST STEREO","code_information":[{"code":"Px00036111191","type":"CDM"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":8346.0,"discounted_cash":2921.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST ADD STEREO","code_information":[{"code":"Px00036111192","type":"CDM"},{"code":"19284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1821.0,"discounted_cash":637.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST 1ST US IMAG","code_information":[{"code":"Px00036111193","type":"CDM"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":6320.0,"discounted_cash":2212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST ADD US IMAG","code_information":[{"code":"Px00036111194","type":"CDM"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST 1ST MR GUIDE","code_information":[{"code":"Px00036111195","type":"CDM"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":10026.0,"discounted_cash":3509.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST ADD MR GUIDE","code_information":[{"code":"Px00036111196","type":"CDM"},{"code":"19288","type":"HCPCS"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":1673.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXPLORE RETROPERITONEAL AREA W OR WO BIOPSY","code_information":[{"code":"Px00036111201","type":"CDM"},{"code":"49010","type":"HCPCS"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":1694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP CDM","code_information":[{"code":"Px00036111202","type":"CDM"},{"code":"62370","type":"HCPCS"}],"standard_charges":[{"gross_charge":2428.0,"discounted_cash":849.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ CDM","code_information":[{"code":"Px00036111211","type":"CDM"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":5426.0,"discounted_cash":1899.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ART BYP GRFT AORTBIFEMORAL","code_information":[{"code":"Px00036111215","type":"CDM"},{"code":"35540","type":"HCPCS"}],"standard_charges":[{"gross_charge":66337.0,"discounted_cash":23217.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA SMALL W/US","code_information":[{"code":"Px00036111216","type":"CDM"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA INTERMEDIATE W/US","code_information":[{"code":"Px00036111217","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2698.0,"discounted_cash":944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA MAJOR W/US","code_information":[{"code":"Px00036111218","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABLATE BONE TUMOR(S) PERQ CRYO","code_information":[{"code":"Px00036111219","type":"CDM"},{"code":"20983","type":"HCPCS"}],"standard_charges":[{"gross_charge":23134.0,"discounted_cash":8096.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"Px00036111222","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":12881.0,"discounted_cash":4508.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"Px00036111223","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":12881.0,"discounted_cash":4508.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"Px00036111224","type":"CDM"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":17942.0,"discounted_cash":6279.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ VERTEBRAL AUGMENTATION USING DEVICE THORACIC","code_information":[{"code":"Px00036111225","type":"CDM"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":56321.0,"discounted_cash":19712.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ VERTEBRAL AUGMENTATION USING DEVICE LUMBAR","code_information":[{"code":"Px00036111226","type":"CDM"},{"code":"22514","type":"HCPCS"}],"standard_charges":[{"gross_charge":56321.0,"discounted_cash":19712.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ VERTEBRAL AUGMENTATION USING DEVICE THORACIC/LUMBAR EA ADDL","code_information":[{"code":"Px00036111227","type":"CDM"},{"code":"22515","type":"HCPCS"}],"standard_charges":[{"gross_charge":17942.0,"discounted_cash":6279.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS/REP SUBQ DEFIBRILLATOR INCLUDING EVAL WHEN PERFORMED","code_information":[{"code":"Px00036111228","type":"CDM"},{"code":"33270","type":"HCPCS"}],"standard_charges":[{"gross_charge":41762.0,"discounted_cash":14616.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ SUBQ IMPLTBL DFB ELCTRD","code_information":[{"code":"Px00036111229","type":"CDM"},{"code":"33271","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL OF SUBQ DEFIBRILLATOR","code_information":[{"code":"Px00036111230","type":"CDM"},{"code":"33272","type":"HCPCS"}],"standard_charges":[{"gross_charge":8391.0,"discounted_cash":2936.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPOS PREV IMPLTBL SUBQ DFB","code_information":[{"code":"Px00036111231","type":"CDM"},{"code":"33273","type":"HCPCS"}],"standard_charges":[{"gross_charge":8391.0,"discounted_cash":2936.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION CERVICAL S&I","code_information":[{"code":"Px00036111234","type":"CDM"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":3914.0,"discounted_cash":1369.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION THORACIC S&I","code_information":[{"code":"Px00036111235","type":"CDM"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":3914.0,"discounted_cash":1369.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION LUMBOSAC S&I","code_information":[{"code":"Px00036111236","type":"CDM"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":4480.0,"discounted_cash":1568.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION 2 OR MORE REGIONS","code_information":[{"code":"Px00036111237","type":"CDM"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":5624.0,"discounted_cash":1968.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING NON-DME LTE 50 SQCM","code_information":[{"code":"Px00036111242","type":"CDM"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":444.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING NON-DME GT 50 SQCM","code_information":[{"code":"Px00036111243","type":"CDM"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":444.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES","code_information":[{"code":"Px00036111250","type":"CDM"},{"code":"27605","type":"HCPCS"}],"standard_charges":[{"gross_charge":8176.0,"discounted_cash":2861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEW REPAIR ELBOW PERCUTANEOUS","code_information":[{"code":"Px00036111251","type":"CDM"},{"code":"24357","type":"HCPCS"}],"standard_charges":[{"gross_charge":14995.0,"discounted_cash":5248.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISION OF THIGH TENDON","code_information":[{"code":"Px00036111252","type":"CDM"},{"code":"27306","type":"HCPCS"}],"standard_charges":[{"gross_charge":8176.0,"discounted_cash":2861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISION OF FOOT FASCIA","code_information":[{"code":"Px00036111253","type":"CDM"},{"code":"28008","type":"HCPCS"}],"standard_charges":[{"gross_charge":8176.0,"discounted_cash":2861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY","code_information":[{"code":"Px00036111261","type":"CDM"},{"code":"35302","type":"HCPCS"}],"standard_charges":[{"gross_charge":28082.0,"discounted_cash":9828.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISION OF TENDON & MUSCLE","code_information":[{"code":"Px00036111263","type":"CDM"},{"code":"23405","type":"HCPCS"}],"standard_charges":[{"gross_charge":24674.0,"discounted_cash":8635.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON","code_information":[{"code":"Px00036111264","type":"CDM"},{"code":"27307","type":"HCPCS"}],"standard_charges":[{"gross_charge":13459.0,"discounted_cash":4710.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISION OF HIP TENDON","code_information":[{"code":"Px00036111265","type":"CDM"},{"code":"27000","type":"HCPCS"}],"standard_charges":[{"gross_charge":8176.0,"discounted_cash":2861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PARTIAL REMOVAL FOOT FASCIA","code_information":[{"code":"Px00036111266","type":"CDM"},{"code":"28060","type":"HCPCS"}],"standard_charges":[{"gross_charge":8176.0,"discounted_cash":2861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVE SPINE ELTRD PREQ ARAY","code_information":[{"code":"Px00036111267","type":"CDM"},{"code":"63661","type":"HCPCS"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":2713.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVISE/REMOVE NEURORECEIVER W/ DETACHABLE CONNECTION ELECTRODE ARRAY","code_information":[{"code":"Px00036111268","type":"CDM"},{"code":"63688","type":"HCPCS"}],"standard_charges":[{"gross_charge":22545.0,"discounted_cash":7890.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVISE SPINE ELTRD PERQ ARAY","code_information":[{"code":"Px00036111270","type":"CDM"},{"code":"63663","type":"HCPCS"}],"standard_charges":[{"gross_charge":37271.0,"discounted_cash":13044.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00036112004","type":"CDM"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF SOFT TISSUES SUPERFICIAL","code_information":[{"code":"Px00036112005","type":"CDM"},{"code":"27040","type":"HCPCS"}],"standard_charges":[{"gross_charge":5520.0,"discounted_cash":1932.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF SOFT TISSUES DEEP","code_information":[{"code":"Px00036112006","type":"CDM"},{"code":"27041","type":"HCPCS"}],"standard_charges":[{"gross_charge":4287.0,"discounted_cash":1500.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY THIGH SOFT TISSUES","code_information":[{"code":"Px00036112011","type":"CDM"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2401.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION PROC FOR ANKLE ARTHROGRAM","code_information":[{"code":"Px00036112017","type":"CDM"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":304.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INS TEMP CARD ELECTRODES DUAL","code_information":[{"code":"Px00036112025","type":"CDM"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":14778.0,"discounted_cash":5172.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR TCAT MITRAL VALVE PERC APPRCH ADDL PROSTHESIS","code_information":[{"code":"Px00036114008","type":"CDM"},{"code":"33419","type":"HCPCS"}],"standard_charges":[{"gross_charge":11999.0,"discounted_cash":4199.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REPAIR TCAT MITRAL VALVE PERC APPRCH INIT PROSTHESIS","code_information":[{"code":"Px00036114009","type":"CDM"},{"code":"33418","type":"HCPCS"}],"standard_charges":[{"gross_charge":68160.0,"discounted_cash":23856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIR IMAGING","code_information":[{"code":"Px00036114033","type":"CDM"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3219.0,"discounted_cash":1126.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIRCUIT W/BALLN ANGIO","code_information":[{"code":"Px00036114034","type":"CDM"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":17088.0,"discounted_cash":5980.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIRCUIT W/STENT & ANGIO","code_information":[{"code":"Px00036114035","type":"CDM"},{"code":"36903","type":"HCPCS"}],"standard_charges":[{"gross_charge":34174.0,"discounted_cash":11960.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALYSIS CIRCUIT","code_information":[{"code":"Px00036114036","type":"CDM"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":17088.0,"discounted_cash":5980.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALY CIRCUIT W/BALN","code_information":[{"code":"Px00036114037","type":"CDM"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":34174.0,"discounted_cash":11960.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALY CIRC W/STNT AN","code_information":[{"code":"Px00036114038","type":"CDM"},{"code":"36906","type":"HCPCS"}],"standard_charges":[{"gross_charge":52267.0,"discounted_cash":18293.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLASTY BALLN DIALY CIRC","code_information":[{"code":"Px00036114039","type":"CDM"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":13067.0,"discounted_cash":4573.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLACE STENT DIALY CIRC W/ANGIO","code_information":[{"code":"Px00036114040","type":"CDM"},{"code":"36908","type":"HCPCS"}],"standard_charges":[{"gross_charge":13067.0,"discounted_cash":4573.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EMBOLIZATION/OCCLU DIALY CIRC","code_information":[{"code":"Px00036114041","type":"CDM"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":13067.0,"discounted_cash":4573.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BALLN TRNSL 1ST ART","code_information":[{"code":"Px00036114042","type":"CDM"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":17088.0,"discounted_cash":5980.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL ADDL ART","code_information":[{"code":"Px00036114043","type":"CDM"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":6836.0,"discounted_cash":2392.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL 1ST VEIN","code_information":[{"code":"Px00036114044","type":"CDM"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":17524.0,"discounted_cash":6133.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNS ADDL VEIN","code_information":[{"code":"Px00036114045","type":"CDM"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":6836.0,"discounted_cash":2392.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S  W/IMG","code_information":[{"code":"Px00036114048","type":"CDM"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":4022.0,"discounted_cash":1407.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ CATH PLCMENT CONT INFUS OR BOLUS C/T W/IMAG","code_information":[{"code":"Px00036114050","type":"CDM"},{"code":"62325","type":"HCPCS"}],"standard_charges":[{"gross_charge":4961.0,"discounted_cash":1736.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ PLACE CATH EPI CONT INF OR  BOLUS L/S W/IMG","code_information":[{"code":"Px00036114052","type":"CDM"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":4961.0,"discounted_cash":1736.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","code_information":[{"code":"Px00036114054","type":"CDM"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2817.0,"discounted_cash":985.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG","code_information":[{"code":"Px00036114055","type":"CDM"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":3940.0,"discounted_cash":1379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV SOFT TISS 1ST IMAG","code_information":[{"code":"Px00036119071","type":"CDM"},{"code":"10035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":680.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRVASC US NONCORONARY 1ST","code_information":[{"code":"Px00036119076","type":"CDM"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRVASC US NONCORONARY ADDL","code_information":[{"code":"Px00036119077","type":"CDM"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS","code_information":[{"code":"Px00036119078","type":"CDM"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":6508.0,"discounted_cash":2277.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, NEW ACCESS","code_information":[{"code":"Px00036119079","type":"CDM"},{"code":"47532","type":"HCPCS"}],"standard_charges":[{"gross_charge":4845.0,"discounted_cash":1695.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, EXTERNAL","code_information":[{"code":"Px00036119080","type":"CDM"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":8315.0,"discounted_cash":2910.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, INTERNAL-EXTERNAL","code_information":[{"code":"Px00036119081","type":"CDM"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":2969.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONVERSION EXT BIL DRG CATH","code_information":[{"code":"Px00036119082","type":"CDM"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":10420.0,"discounted_cash":3647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE BILIARY DRG CATH","code_information":[{"code":"Px00036119083","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":10420.0,"discounted_cash":3647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOVAL BILIARY DRG CATH","code_information":[{"code":"Px00036119084","type":"CDM"},{"code":"47537","type":"HCPCS"}],"standard_charges":[{"gross_charge":5236.0,"discounted_cash":1832.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ PLMT BILE DUCT STENT, EXISTING ACCESS","code_information":[{"code":"Px00036119085","type":"CDM"},{"code":"47538","type":"HCPCS"}],"standard_charges":[{"gross_charge":8606.0,"discounted_cash":3012.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ PLMT BILE DUCT STENT, NEW ACCESS","code_information":[{"code":"Px00036119086","type":"CDM"},{"code":"47539","type":"HCPCS"}],"standard_charges":[{"gross_charge":15782.0,"discounted_cash":5523.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ PLMT BILE DUCT STENT, NEW ACCESS INT-EXT","code_information":[{"code":"Px00036119087","type":"CDM"},{"code":"47540","type":"HCPCS"}],"standard_charges":[{"gross_charge":15782.0,"discounted_cash":5523.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW CDM","code_information":[{"code":"Px00036119088","type":"CDM"},{"code":"47541","type":"HCPCS"}],"standard_charges":[{"gross_charge":10420.0,"discounted_cash":3647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOLUMINAL BX BILIARY TREE, SINGL/MLTP","code_information":[{"code":"Px00036119090","type":"CDM"},{"code":"47543","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SCLEROTX FLUID COLLECTION","code_information":[{"code":"Px00036119091","type":"CDM"},{"code":"49185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5610.0,"discounted_cash":1963.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM, NEW ACCESS","code_information":[{"code":"Px00036119092","type":"CDM"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3833.0,"discounted_cash":1341.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM, EXISTING ACCESS","code_information":[{"code":"Px00036119093","type":"CDM"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":3833.0,"discounted_cash":1341.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"Px00036119094","type":"CDM"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":15818.0,"discounted_cash":5536.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT NEPHROURETERAL CATHETER, NEW ACCESS","code_information":[{"code":"Px00036119095","type":"CDM"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":15499.0,"discounted_cash":5424.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONVERT NEPHROSTOMY CATHETER, PRE-EXISTING TRACT","code_information":[{"code":"Px00036119096","type":"CDM"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":8726.0,"discounted_cash":3054.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE NEPHROSTOMY CATH","code_information":[{"code":"Px00036119097","type":"CDM"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":4855.0,"discounted_cash":1699.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT URETERAL STENT PRQ, PRE-EXISTING TRACT","code_information":[{"code":"Px00036119099","type":"CDM"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":8740.0,"discounted_cash":3059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT URETERAL STENT PRQ, NEW ACCESS","code_information":[{"code":"Px00036119100","type":"CDM"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":9176.0,"discounted_cash":3211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT URETERAL STENT PRQ, NEW ACCESS SEP CATH","code_information":[{"code":"Px00036119101","type":"CDM"},{"code":"50695","type":"HCPCS"}],"standard_charges":[{"gross_charge":9176.0,"discounted_cash":3211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BALLOON DILATE URTRL STRIX","code_information":[{"code":"Px00036119103","type":"CDM"},{"code":"50706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ ART M-THROMBECT &/NFS","code_information":[{"code":"Px00036119104","type":"CDM"},{"code":"61645","type":"HCPCS"}],"standard_charges":[{"gross_charge":32469.0,"discounted_cash":11364.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC PRLNG ADMN RX AGNT 1ST","code_information":[{"code":"Px00036119105","type":"CDM"},{"code":"61650","type":"HCPCS"}],"standard_charges":[{"gross_charge":22542.0,"discounted_cash":7889.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC PRLNG ADMN RX AGNT ADD","code_information":[{"code":"Px00036119106","type":"CDM"},{"code":"61651","type":"HCPCS"}],"standard_charges":[{"gross_charge":17256.0,"discounted_cash":6039.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VNPNXR 3 YEARS/> PHYS/QHP SKILL- MIDLINE CATHETER INSERTION > 3 YR","code_information":[{"code":"Px00036155555","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":826.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLACEMENT NEEDLE INTRAOSSEOUS INFUSION","code_information":[{"code":"Px00036166666","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOD SEDATION ENDO SERVICE GT/5YRS","code_information":[{"code":"Px00037010102","type":"CDM"},{"code":"G0500","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":115.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS LT/5YRS","code_information":[{"code":"Px00037010151","type":"CDM"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":115.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS GT/5YRS","code_information":[{"code":"Px00037010152","type":"CDM"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":115.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"Px00037010153","type":"CDM"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":92.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS LT/5YRS","code_information":[{"code":"Px00037010154","type":"CDM"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":115.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15MINS GT/5YRS","code_information":[{"code":"Px00037010155","type":"CDM"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":115.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"Px00037010156","type":"CDM"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":92.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT","code_information":[{"code":"Px00039010002","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AUTOLOGOUS BLOOD PROCESS WB","code_information":[{"code":"Px00039010009","type":"CDM"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHOLE BLOOD FOR TRANSFUSION","code_information":[{"code":"Px00039010010","type":"CDM"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":173.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD SPLIT UNIT RBC","code_information":[{"code":"Px00039010013","type":"CDM"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED","code_information":[{"code":"Px00039010015","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA EA UNIT FRZ W/IN 8 HR","code_information":[{"code":"Px00039010017","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLATELETS EACH UNIT","code_information":[{"code":"Px00039010018","type":"CDM"},{"code":"P9019","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010022","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WASHED RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010024","type":"CDM"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":236.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS","code_information":[{"code":"Px00039010030","type":"CDM"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCED","code_information":[{"code":"Px00039010031","type":"CDM"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDU IRRAD","code_information":[{"code":"Px00039010033","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC IRRADIATED","code_information":[{"code":"Px00039010034","type":"CDM"},{"code":"P9038","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC DEGLYCEROLIZED","code_information":[{"code":"Px00039010035","type":"CDM"},{"code":"P9039","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":380.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE REDUCED PLASMA","code_information":[{"code":"Px00039010036","type":"CDM"},{"code":"P9044","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA FRZ BETWEEN 8-24HOUR","code_information":[{"code":"Px00039010045","type":"CDM"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT POOLED","code_information":[{"code":"Px00039010054","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED","code_information":[{"code":"Px00039010055","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC PRETREATMENT DENSITY GRADIENT SEPERATION","code_information":[{"code":"Px00039010062","type":"CDM"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.8,"discounted_cash":32.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC PLATELETS PHERESIS PATH REDU","code_information":[{"code":"Px00039010064","type":"CDM"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.0,"discounted_cash":511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC PRETREATMENT - HYPOTONIC WASH","code_information":[{"code":"Px00039010093","type":"CDM"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CA REGION SENDOUT LAB - AMERICAN RED CROSS"}]},{"description":"HC BLOOD TRANSFUSION EA UNIT CDM","code_information":[{"code":"Px00039110001","type":"CDM"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":447.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED WASHED","code_information":[{"code":"Px00039910006","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG BIL W CAD","code_information":[{"code":"Px00040110004","type":"CDM"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG UNI W CAD","code_information":[{"code":"Px00040110005","type":"CDM"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SCREENING BREAST TOMOSYNTHESIS BI","code_information":[{"code":"Px00040110020","type":"CDM"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TOMOSYNTHESIS MAMMO UNI OR BIL DIAGNOSTIC","code_information":[{"code":"Px00040110021","type":"CDM"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM OF HEAD","code_information":[{"code":"Px00040210001","type":"CDM"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":2640.0,"discounted_cash":924.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US EXAM OF HEAD AND NECK","code_information":[{"code":"Px00040210004","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1949.0,"discounted_cash":682.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US EXAM CHEST","code_information":[{"code":"Px00040210005","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US EXAM ABDOMEN COMPLETE","code_information":[{"code":"Px00040210008","type":"CDM"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2692.0,"discounted_cash":942.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC LIMITED","code_information":[{"code":"Px00040210009","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.0,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL COMPLETE","code_information":[{"code":"Px00040210010","type":"CDM"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2149.0,"discounted_cash":752.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL LIMITED","code_information":[{"code":"Px00040210011","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":680.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US EXAM KIDNEY TRANSPLANT W/DOPPLER","code_information":[{"code":"Px00040210012","type":"CDM"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":743.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US SPINAL CANAL","code_information":[{"code":"Px00040210013","type":"CDM"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS SINGLE FETUS CDM","code_information":[{"code":"Px00040210014","type":"CDM"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":390.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS ADDL FETUS CDM","code_information":[{"code":"Px00040210015","type":"CDM"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":390.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US OB AFTER 1ST TRIMEST 1/1ST FETUS","code_information":[{"code":"Px00040210016","type":"CDM"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":390.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US OB AFTER 1ST TRIMESTER ADD FETUS","code_information":[{"code":"Px00040210017","type":"CDM"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":390.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US OB DETAILED SINGLE FETUS CDM","code_information":[{"code":"Px00040210018","type":"CDM"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":390.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US OB LIMITED FETUS(S) CDM","code_information":[{"code":"Px00040210022","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":246.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US OB TRANSVAGINAL CDM","code_information":[{"code":"Px00040210024","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":464.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/NST CDM","code_information":[{"code":"Px00040210025","type":"CDM"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.0,"discounted_cash":629.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/O NST CDM","code_information":[{"code":"Px00040210026","type":"CDM"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.0,"discounted_cash":629.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00040210033","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":464.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM UTERUS","code_information":[{"code":"Px00040210034","type":"CDM"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC FOLLICLE LIMITED","code_information":[{"code":"Px00040210035","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.0,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US EXAM SCROTUM & CONTENTS","code_information":[{"code":"Px00040210036","type":"CDM"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.0,"discounted_cash":732.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US TRANSRECTAL","code_information":[{"code":"Px00040210037","type":"CDM"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":686.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US JOINT COMPLETE","code_information":[{"code":"Px00040210041","type":"CDM"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1544.0,"discounted_cash":540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00040210043","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.0,"discounted_cash":405.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US INFANT HIPS DYNAMIC","code_information":[{"code":"Px00040210045","type":"CDM"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":1921.0,"discounted_cash":672.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US GUIDE COMPRESSION REPAIR","code_information":[{"code":"Px00040210048","type":"CDM"},{"code":"76936","type":"HCPCS"}],"standard_charges":[{"gross_charge":2692.0,"discounted_cash":942.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00040210049","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.0,"discounted_cash":494.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210052","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.0,"discounted_cash":474.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US GUIDE INTRAOPERATIVE","code_information":[{"code":"Px00040210059","type":"CDM"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":437.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAMINATION PROCEDURE UNLISTED","code_information":[{"code":"Px00040210061","type":"CDM"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US UMBILICAL ARTERY ECHO CDM","code_information":[{"code":"Px00040210076","type":"CDM"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":129.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US PELVIC NON-OB COMPLETE","code_information":[{"code":"Px00040210093","type":"CDM"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.0,"discounted_cash":701.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ABDOMEN LIMITED","code_information":[{"code":"Px00040210104","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":519.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00040210112","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.0,"discounted_cash":405.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210113","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.0,"discounted_cash":474.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI COMPLETE","code_information":[{"code":"Px00040210136","type":"CDM"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI LIMITED","code_information":[{"code":"Px00040210137","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":173.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ABD AORTA SCRN AAA","code_information":[{"code":"Px00040210142","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":680.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US TARGET DYNAMIC MICROBUBBLE 1ST LESION","code_information":[{"code":"Px00040210148","type":"CDM"},{"code":"76978","type":"HCPCS"}],"standard_charges":[{"gross_charge":3703.0,"discounted_cash":1296.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LES","code_information":[{"code":"Px00040210149","type":"CDM"},{"code":"76979","type":"HCPCS"}],"standard_charges":[{"gross_charge":1851.0,"discounted_cash":647.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ULTRASOUND ELASTOGRAPHY PARENCHYMA","code_information":[{"code":"Px00040210150","type":"CDM"},{"code":"76981","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":156.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION","code_information":[{"code":"Px00040210151","type":"CDM"},{"code":"76982","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":156.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ELASTOGRAPHY EA ADDL TARGET LESION","code_information":[{"code":"Px00040210152","type":"CDM"},{"code":"76983","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN BIL W CAD","code_information":[{"code":"Px00040310004","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN UNIL/BIL W CAD","code_information":[{"code":"Px00040310005","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTUBATION CDM","code_information":[{"code":"Px00041010003","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2152.0,"discounted_cash":753.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD SAMPLING CAPILLARY CDM","code_information":[{"code":"Px00041010004","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW ARTERIAL PUNCTURE CDM","code_information":[{"code":"Px00041010006","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00041010007","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":4401.0,"discounted_cash":1540.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00041010012","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY OVERNIGHT STUDY CDM","code_information":[{"code":"Px00041010013","type":"CDM"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT CDM","code_information":[{"code":"Px00041010015","type":"CDM"},{"code":"94772","type":"HCPCS"}],"standard_charges":[{"gross_charge":6562.0,"discounted_cash":2296.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL CHEST WALL OSCILL CDM","code_information":[{"code":"Px00041010023","type":"CDM"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":1047.0,"discounted_cash":366.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONTINUOUS INHALATION TREATMENT EA ADDL HR","code_information":[{"code":"Px00041010237","type":"CDM"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL CDM","code_information":[{"code":"Px00041010261","type":"CDM"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ CDM","code_information":[{"code":"Px00041010263","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION FIRST DAY CDM","code_information":[{"code":"Px00041010290","type":"CDM"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":5445.0,"discounted_cash":1905.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010296","type":"CDM"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5445.0,"discounted_cash":1905.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP DAILY CDM","code_information":[{"code":"Px00041010325","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.0,"discounted_cash":473.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010328","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.0,"discounted_cash":473.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB GROUP CDM","code_information":[{"code":"Px00041010331","type":"CDM"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":1671.0,"discounted_cash":584.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB RESP FUNCTION, INDIV CDM","code_information":[{"code":"Px00041010332","type":"CDM"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":129.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATION POSTURAL DRAINAGE 3 POSITIONS OR LESS","code_information":[{"code":"Px00041010338","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATPOSTURAL DRAINAGE GT/4 POSITIONS CDM","code_information":[{"code":"Px00041010341","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB STRENGTH/ENDURANCE, INDIV CDM","code_information":[{"code":"Px00041010363","type":"CDM"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONGENITAL HEART DISEASE SCREEN PULSE OX MULT DET","code_information":[{"code":"Px00041010384","type":"CDM"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SURFACTANT ADMINISTRATION W/O INTUBATION (LMA/LISA) CDM","code_information":[{"code":"Px00041044444","type":"CDM"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRAPULMONARY SURFACTANT ADMINISTJ THROUGH TUBE PHYS/QHP CDM","code_information":[{"code":"Px00041210001","type":"CDM"},{"code":"94610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INHALATION TREATMENT DAILY","code_information":[{"code":"Px00041210006","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.0,"discounted_cash":446.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH","code_information":[{"code":"Px00041210007","type":"CDM"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":453.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CONTINUOUS INHALATION TREATMENT 1ST HR CDM","code_information":[{"code":"Px00041210008","type":"CDM"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.0,"discounted_cash":465.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEBULIZER CONTINUOUS EA SUBSEQUENT HOUR CDM","code_information":[{"code":"Px00041210044","type":"CDM"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ORTHOTIC/PROSTH MGMT & TRAINING SBSQ ENCTR PER 15MIN","code_information":[{"code":"Px00042010003","type":"CDM"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CDM","code_information":[{"code":"Px00042010010","type":"CDM"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CDM","code_information":[{"code":"Px00042010011","type":"CDM"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM","code_information":[{"code":"Px00042010014","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM","code_information":[{"code":"Px00042010015","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97116 GAIT TRAINING THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00042010016","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97760 ORTHOTIC MGMT AND TRAINING EA 15 MIN","code_information":[{"code":"Px00042010018","type":"CDM"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STRAPPING SHOULDER","code_information":[{"code":"Px00042010073","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"Px00042010080","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT BIL","code_information":[{"code":"Px00042010083","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","code_information":[{"code":"Px00042010084","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING","code_information":[{"code":"Px00042010099","type":"CDM"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE - PER DAY","code_information":[{"code":"Px00042010108","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.0,"discounted_cash":285.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS TRACTION MECHANICAL","code_information":[{"code":"Px00042010110","type":"CDM"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ELEC STIMJ UNATTENDED","code_information":[{"code":"Px00042010113","type":"CDM"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPLICATION MODALITY 1 OR MORE AREAS WHIRLPOOL","code_information":[{"code":"Px00042010117","type":"CDM"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INFRARED THERAPY","code_information":[{"code":"Px00042010121","type":"CDM"},{"code":"97026","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ATTENDED ESTIM EA 15 MIN","code_information":[{"code":"Px00042010124","type":"CDM"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS IONTOPHORESIS EA 15 MIN","code_information":[{"code":"Px00042010125","type":"CDM"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS CONTRAST BATHS EA 15 MIN","code_information":[{"code":"Px00042010126","type":"CDM"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ULTRASOUND EA 15 MIN","code_information":[{"code":"Px00042010127","type":"CDM"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010131","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010139","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EA 15 MIN GAIT TRAING W/STAIR","code_information":[{"code":"Px00042010142","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EACH 15 MINUTES MASSAGE","code_information":[{"code":"Px00042010144","type":"CDM"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL MEDICINE PROCEDURE","code_information":[{"code":"Px00042010146","type":"CDM"},{"code":"97139","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES","code_information":[{"code":"Px00042010150","type":"CDM"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC PROCEDURES GROUP 2 OR MORE INDIVIDUALS","code_information":[{"code":"Px00042010153","type":"CDM"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"Px00042010160","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC WHEELCHAIR MGMT EA 15 MIN","code_information":[{"code":"Px00042010165","type":"CDM"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS","code_information":[{"code":"Px00042010166","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":317.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","code_information":[{"code":"Px00042010173","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","code_information":[{"code":"Px00042010182","type":"CDM"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":266.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP LTE/50 SQ CM","code_information":[{"code":"Px00042010188","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":266.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP GT/50 SQ CM","code_information":[{"code":"Px00042010195","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":317.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","code_information":[{"code":"Px00042010248","type":"CDM"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010264","type":"CDM"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010265","type":"CDM"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC TREAT/MOD PROC INI 30 MIN","code_information":[{"code":"Px00042010423","type":"CDM"},{"code":"X3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":505.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC TREAT/MOD PROC ADDL 15 MIN","code_information":[{"code":"Px00042010426","type":"CDM"},{"code":"X3910","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC SINGLE PROCEDURE INI 30 MIN","code_information":[{"code":"Px00042010450","type":"CDM"},{"code":"X3904","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":368.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC SNGL PROCEDURE ADDL 15 MIN","code_information":[{"code":"Px00042010451","type":"CDM"},{"code":"X3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SPEECH-HEARING THERAPY INDIV CDM","code_information":[{"code":"Px00042050002","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":225.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE CDM","code_information":[{"code":"Px00042050005","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SPEECH SOUND LANG COMPREHEN EXTENDED CDM","code_information":[{"code":"Px00042050006","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":416.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE CDM","code_information":[{"code":"Px00042050007","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR CDM","code_information":[{"code":"Px00042050008","type":"CDM"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":365.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER EXERCISES PX 1 OR MORE AREAS EACH 15MINS CDM","code_information":[{"code":"Px00042050009","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY NEUROMUSC REEDUCA PX 1 OR MORE AREAS EACH 15MINS CDM","code_information":[{"code":"Px00042050010","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PX 1 OR MORE AREAS EA 15 MIN GAIT TRAING W/STAIR CDM","code_information":[{"code":"Px00042050011","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER IVNTJ COG FUNCJ CNTCT 1ST 15MINS CDM","code_information":[{"code":"Px00042050012","type":"CDM"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THER IVNTJ COG FUNCJ CNTCT EA ADDL 15MINS CDM","code_information":[{"code":"Px00042050013","type":"CDM"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042050014","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":243.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION MOD COMPLEX CDM","code_information":[{"code":"Px00042050015","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042050016","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY PT RE-EVAL EST PLAN CARE 20MINS CDM","code_information":[{"code":"Px00042050017","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042050018","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":243.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION MOD COMPLEX CDM","code_information":[{"code":"Px00042050019","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042050020","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY OT RE-EVAL EST PLAN CARE 30MINS CDM","code_information":[{"code":"Px00042050021","type":"CDM"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY SELF-CARE/HOME MGMT TRAINING EACH 15MINS CDM","code_information":[{"code":"Px00042050022","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VIRTUAL THERAPY THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15MINS CDM","code_information":[{"code":"Px00042050025","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC VIRTUAL THERAPY PT SINGLE PROCEDURE 1 AREA 1ST 30 MINS CDM","code_information":[{"code":"Px00042050030","type":"CDM"},{"code":"X3904","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC VIRTUAL THERAPY PT SINGLE PROCEDURE 1 AREA EA ADDL 15MINS CDM","code_information":[{"code":"Px00042050031","type":"CDM"},{"code":"X3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC PT EVALUATION INITIAL 30MINS PLUS REPORT CDM","code_information":[{"code":"Px00042410042","type":"CDM"},{"code":"X3920","type":"HCPCS"}],"standard_charges":[{"gross_charge":1685.0,"discounted_cash":589.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC PT EVALUATION ADDL 15 MIN","code_information":[{"code":"Px00042410044","type":"CDM"},{"code":"X3922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1165.0,"discounted_cash":407.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410066","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":258.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410067","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00042410068","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PT RE-EVAL EST PLAN CARE 20 MINS","code_information":[{"code":"Px00042410069","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410070","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":258.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97162 PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410071","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042410072","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97164 PT RE-EVAL ESTAB PLAN OF CARE CDM","code_information":[{"code":"Px00042410073","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC VIRTUAL THERAPY PT INITIAL 30 MINUTES PLUS REPORT CDM","code_information":[{"code":"Px00042450032","type":"CDM"},{"code":"X3920","type":"HCPCS"}],"standard_charges":[{"gross_charge":1348.0,"discounted_cash":471.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC VIRTUAL THERAPY PT EACH ADDL 15 MINUTES CDM","code_information":[{"code":"Px00042450033","type":"CDM"},{"code":"X3922","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CAREGIVER IND FUNCTIONAL TRAINING W/O PATIENT PRESENT EA ADD 15 MIN CDM","code_information":[{"code":"Px00043000008","type":"CDM"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS PARAFFIN BATH","code_information":[{"code":"Px00043010004","type":"CDM"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97535 SELF CARE MGMT TRAINING EA 15 MIN CDM","code_information":[{"code":"Px00043010005","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"Px00043010008","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMMUNITY/WORK REINTEGRATION EA 15 MIN","code_information":[{"code":"Px00043010014","type":"CDM"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC UNLIST MODALITY SPEC TYPE&TIME CONSTANT ATTEND","code_information":[{"code":"Px00043010061","type":"CDM"},{"code":"97039","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FINGER DYNAMIC SPLINT-APPL/FAB","code_information":[{"code":"Px00043010124","type":"CDM"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC OT THER TREATMENT 30 MIN","code_information":[{"code":"Px00043010156","type":"CDM"},{"code":"X4110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":368.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC OT THER TREATMNT ADDL 15MIN","code_information":[{"code":"Px00043010157","type":"CDM"},{"code":"X4112","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC OT EVALUATION 30 MIN","code_information":[{"code":"Px00043410042","type":"CDM"},{"code":"X4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1685.0,"discounted_cash":589.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC OT EVALUATION ADDL 15 MIN","code_information":[{"code":"Px00043410043","type":"CDM"},{"code":"X4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":295.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION LOW COMPLEX","code_information":[{"code":"Px00043410045","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":258.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION MOD COMPLEXITY","code_information":[{"code":"Px00043410046","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00043410047","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OT RE-EVALUATION ESTABLISHED PLAN OF CARE","code_information":[{"code":"Px00043410048","type":"CDM"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00043410050","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":258.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97166 OT EVALUATION MOD COMPLEXITY CDM","code_information":[{"code":"Px00043410051","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97167 OT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00043410052","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL","code_information":[{"code":"Px00044010016","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":225.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPEECH LANG VOICE COMMJ AUDITRY - GROUP 2 OR MORE CDM","code_information":[{"code":"Px00044010024","type":"CDM"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"Px00044010042","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":225.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ORAL SPEECH DEVICE EVAL","code_information":[{"code":"Px00044010050","type":"CDM"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR CDM","code_information":[{"code":"Px00044010083","type":"CDM"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":365.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM","code_information":[{"code":"Px00044010126","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":416.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE CDM","code_information":[{"code":"Px00044010127","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC SPEECH LANGUAGE THERAPY 30MIN","code_information":[{"code":"Px00044010128","type":"CDM"},{"code":"X4304","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":377.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC SPEECH LANGUAGE THERAPY 60MIN","code_information":[{"code":"Px00044010129","type":"CDM"},{"code":"X4303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1778.0,"discounted_cash":622.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM","code_information":[{"code":"Px00044010145","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":225.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION","code_information":[{"code":"Px00044410026","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOTION FLUOROSCOPY/SWALLOW","code_information":[{"code":"Px00044410043","type":"CDM"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY SWALLOW TST (FEES)","code_information":[{"code":"Px00044410054","type":"CDM"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"Px00044410063","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE CDM","code_information":[{"code":"Px00044410064","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC LANGUAGE EVAL","code_information":[{"code":"Px00044410068","type":"CDM"},{"code":"X4300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2908.0,"discounted_cash":1017.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MC SPEECH EVAL","code_information":[{"code":"Px00044410069","type":"CDM"},{"code":"X4301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2045.0,"discounted_cash":715.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92521 EVALUATION OF SPEECH FLUENCY CDM","code_information":[{"code":"Px00044410070","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92522 EVALUATE SPEECH PRODUCTION CDM","code_information":[{"code":"Px00044410071","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":292.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM","code_information":[{"code":"Px00044410072","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":416.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION CDM","code_information":[{"code":"Px00045000001","type":"CDM"},{"code":"28675","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045000002","type":"CDM"},{"code":"27570","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TAP BLOCK BILATERAL BY INJECTION(S) CDM","code_information":[{"code":"Px00045000003","type":"CDM"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":360.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM","code_information":[{"code":"Px00045000005","type":"CDM"},{"code":"46255","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045000006","type":"CDM"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":482.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD FEM NRV CONT NFS CATH IMG GDN CDM","code_information":[{"code":"Px00045000007","type":"CDM"},{"code":"64448","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM CDM","code_information":[{"code":"Px00045000008","type":"CDM"},{"code":"57022","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL CDM","code_information":[{"code":"Px00045000009","type":"CDM"},{"code":"42330","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM CDM","code_information":[{"code":"Px00045000012","type":"CDM"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION AND/OR INJECTION THYROID CYST CDM","code_information":[{"code":"Px00045000013","type":"CDM"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT CDM","code_information":[{"code":"Px00045000014","type":"CDM"},{"code":"11971","type":"HCPCS"}],"standard_charges":[{"gross_charge":5688.0,"discounted_cash":1990.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION FLEXOR TENDON SHEATH WRIST CDM","code_information":[{"code":"Px00045000015","type":"CDM"},{"code":"25001","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON CDM","code_information":[{"code":"Px00045000016","type":"CDM"},{"code":"26460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TONSIL ASPIRATION CDM","code_information":[{"code":"Px00045000017","type":"CDM"},{"code":"45000017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT CDM","code_information":[{"code":"Px00045000019","type":"CDM"},{"code":"27496","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TAP BLOCK UNILATERAL BY INJECTION(S) CDM","code_information":[{"code":"Px00045000020","type":"CDM"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":296.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION INTRALESIONAL UP TO AND INCLUD 7 LESIONS CDM","code_information":[{"code":"Px00045000021","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RECTUM FOREIGN BODY REMOVAL WITH SPECULUM AND/OR FORCEPS CDM","code_information":[{"code":"Px00045000022","type":"CDM"},{"code":"45999","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION CERVICAL DILATOR SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045000023","type":"CDM"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED J TUBE REPLACEMENT CDM","code_information":[{"code":"Px00045000024","type":"CDM"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1942.0,"discounted_cash":679.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ CDM","code_information":[{"code":"Px00045000025","type":"CDM"},{"code":"28496","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOID REDUCTION VIA FORCEP CDM","code_information":[{"code":"Px00045000030","type":"CDM"},{"code":"46999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":666.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP CDM","code_information":[{"code":"Px00045000032","type":"CDM"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRUNK/ARMS/LEGS TO 100 SQ CM 1ST 25 SQ CM","code_information":[{"code":"Px00045000051","type":"CDM"},{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS TO 100 SQ CM EA ADD 25 SQ CM","code_information":[{"code":"Px00045000052","type":"CDM"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":218.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS GT/ 100 SQ CM 1ST 100 SQ CM","code_information":[{"code":"Px00045000053","type":"CDM"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.0,"discounted_cash":1626.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS GT/100 SQ CM EA ADD 100 SQCM","code_information":[{"code":"Px00045000054","type":"CDM"},{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1815.0,"discounted_cash":635.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET TO 100 SQ CM 1ST 25 SQCM","code_information":[{"code":"Px00045000055","type":"CDM"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET EA ADD 25 SQ CM","code_information":[{"code":"Px00045000056","type":"CDM"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":218.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUBST APP TO FACE/NECK/HAND/FEET 1ST 100 SQCM","code_information":[{"code":"Px00045000057","type":"CDM"},{"code":"C5277","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET EA ADD 100 SQCM","code_information":[{"code":"Px00045000058","type":"CDM"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":218.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045000059","type":"CDM"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NJX ANES STELLATE GANGLION CRV SYMPATHETIC CDM","code_information":[{"code":"Px00045000060","type":"CDM"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS CDM","code_information":[{"code":"Px00045000061","type":"CDM"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":266.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR CDM","code_information":[{"code":"Px00045000062","type":"CDM"},{"code":"41825","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH CDM","code_information":[{"code":"Px00045000063","type":"CDM"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG CDM","code_information":[{"code":"Px00045000064","type":"CDM"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.0,"discounted_cash":861.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL CDM","code_information":[{"code":"Px00045000065","type":"CDM"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT CDM","code_information":[{"code":"Px00045000066","type":"CDM"},{"code":"53855","type":"HCPCS"}],"standard_charges":[{"gross_charge":3885.0,"discounted_cash":1359.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN CDM","code_information":[{"code":"Px00045000067","type":"CDM"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":19192.0,"discounted_cash":6717.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL CDM","code_information":[{"code":"Px00045000068","type":"CDM"},{"code":"42320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH CDM","code_information":[{"code":"Px00045000069","type":"CDM"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":10420.0,"discounted_cash":3647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I CDM","code_information":[{"code":"Px00045000070","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":10420.0,"discounted_cash":3647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION PILONIDAL CYST/SINUS COMPLICATED CDM","code_information":[{"code":"Px00045000071","type":"CDM"},{"code":"11772","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ NEUROFIBROMATA XTNSV FACE HEAD NECK GT/50 CDM","code_information":[{"code":"Px00045000072","type":"CDM"},{"code":"0419T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ NEUROFIBROMATA XTNSV TRUNK EXTGT/100 CDM","code_information":[{"code":"Px00045000073","type":"CDM"},{"code":"0420T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION OF CATHETER VEIN CDM","code_information":[{"code":"Px00045000074","type":"CDM"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":2305.0,"discounted_cash":806.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY SOFT TISSUE NECK/THORAX CDM","code_information":[{"code":"Px00045000076","type":"CDM"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5608.0,"discounted_cash":1962.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD BRACH PLEX CONT NFS CATH IMG CDM","code_information":[{"code":"Px00045000077","type":"CDM"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SALIVARY STONE CDM","code_information":[{"code":"Px00045000078","type":"CDM"},{"code":"42699","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF CDM","code_information":[{"code":"Px00045000080","type":"CDM"},{"code":"35876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.0,"discounted_cash":2417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ABDOMINAL WOUND DEHISCENSE TREATMENT CDM","code_information":[{"code":"Px00045000081","type":"CDM"},{"code":"49900","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED VBAC DELIVERY ONLY CDM","code_information":[{"code":"Px00045000082","type":"CDM"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATION TOE INTERPHALANGEAL JOINT CDM","code_information":[{"code":"Px00045000083","type":"CDM"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED URETHRAL FB REMOVAL CDM","code_information":[{"code":"Px00045000084","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EGD PLACE GASTROSTOMY TUBE CDM","code_information":[{"code":"Px00045000085","type":"CDM"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2913.0,"discounted_cash":1019.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES CDM","code_information":[{"code":"Px00045000086","type":"CDM"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL ANAL SETON OTHER MARKER CDM","code_information":[{"code":"Px00045000087","type":"CDM"},{"code":"46030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2251.0,"discounted_cash":787.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC BARTHOLINS GLAND/CYST CDM","code_information":[{"code":"Px00045000088","type":"CDM"},{"code":"56740","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU CDM","code_information":[{"code":"Px00045000089","type":"CDM"},{"code":"65290","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYTIC VENOUS THERAPY CDM","code_information":[{"code":"Px00045000090","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":12496.0,"discounted_cash":4373.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL CDM","code_information":[{"code":"Px00045000091","type":"CDM"},{"code":"67015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3561.0,"discounted_cash":1246.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BRNCHSC RF DSTRJ PULM NRV BI MAINSTEM BRONCHI CDM","code_information":[{"code":"Px00045000092","type":"CDM"},{"code":"0781T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3125.0,"discounted_cash":1093.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BRNCHSC RF DSTRJ PULM NRV UNI MAINSTEM BRONCHUS CDM","code_information":[{"code":"Px00045000093","type":"CDM"},{"code":"0782T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3125.0,"discounted_cash":1093.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045000096","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045000097","type":"CDM"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":21.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SUBCONJUNCTIVAL INJECTION CDM","code_information":[{"code":"Px00045000098","type":"CDM"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":280.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE PHARYNX WOUND/INJURY CDM","code_information":[{"code":"Px00045000100","type":"CDM"},{"code":"42900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF FLOOR OF MOUTH CDM","code_information":[{"code":"Px00045000107","type":"CDM"},{"code":"41108","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045000108","type":"CDM"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PRTL HYMENECTOMY/REV HYMENAL RING CDM","code_information":[{"code":"Px00045000109","type":"CDM"},{"code":"56700","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES CDM","code_information":[{"code":"Px00045000110","type":"CDM"},{"code":"20693","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY VULVA/PERINEUM 1 LESION SPX CDM","code_information":[{"code":"Px00045000121","type":"CDM"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1543.0,"discounted_cash":540.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NEG PRESSURE WOUND THERAPY UTI DISPOSABLE NON-DME LTE 50SQ","code_information":[{"code":"Px00045000122","type":"CDM"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":444.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED 68020 INCISION CONJUNCTIVA DRAINAGE OF CYST CDM","code_information":[{"code":"Px00045000125","type":"CDM"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3952.0,"discounted_cash":1383.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX","code_information":[{"code":"Px00045000132","type":"CDM"},{"code":"61020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3254.0,"discounted_cash":1138.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NEGATIVE PRESSURE WOUND THERAPY DME >50 SQCM CDM","code_information":[{"code":"Px00045000133","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":317.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NEGATIVE PRESSURE WOUND THERAPY NON-DME >50 SQCM CDM","code_information":[{"code":"Px00045000134","type":"CDM"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":444.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION VAGINAL LESIONS SIMPLE CDM","code_information":[{"code":"Px00045000135","type":"CDM"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":10424.0,"discounted_cash":3648.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM CHEST CDM","code_information":[{"code":"Px00045000136","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00045000137","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.0,"discounted_cash":382.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00045000138","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":447.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED ABDOMEN LIMITED CDM","code_information":[{"code":"Px00045000139","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.0,"discounted_cash":489.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD CDM","code_information":[{"code":"Px00045000140","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM OF HEAD AND NECK CDM","code_information":[{"code":"Px00045000141","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"discounted_cash":643.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM PELVIC LIMITED CDM","code_information":[{"code":"Px00045000142","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":355.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED OB LIMITED FETUS(S) CDM","code_information":[{"code":"Px00045000143","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED RETROPERITONEAL LIMITED CDM","code_information":[{"code":"Px00045000144","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.0,"discounted_cash":641.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC US ED BREAST UNI LIMITED CDM","code_information":[{"code":"Px00045000145","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":164.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT BIG TOE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045001299","type":"CDM"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ACNE SURGERY CDM","code_information":[{"code":"Px00045001301","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CURETTAGE POSTPARTUM CDM","code_information":[{"code":"Px00045001309","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE DRUG IMPLANT DEVICE CDM","code_information":[{"code":"Px00045001312","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESS FASCIOTOMY FINGERS/HAND CDM","code_information":[{"code":"Px00045001313","type":"CDM"},{"code":"26037","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OF EXTERMITY ARTERY CDM","code_information":[{"code":"Px00045010001","type":"CDM"},{"code":"37618","type":"HCPCS"}],"standard_charges":[{"gross_charge":7359.0,"discounted_cash":2575.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM CDM","code_information":[{"code":"Px00045010002","type":"CDM"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":6420.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INHALATION TREATMENT CDM","code_information":[{"code":"Px00045010003","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.0,"discounted_cash":446.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC CDM","code_information":[{"code":"Px00045010004","type":"CDM"},{"code":"21110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM","code_information":[{"code":"Px00045010005","type":"CDM"},{"code":"49505","type":"HCPCS"}],"standard_charges":[{"gross_charge":5049.0,"discounted_cash":1767.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00045010006","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":9944.0,"discounted_cash":3480.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00045010007","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":12122.0,"discounted_cash":4242.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY CDM","code_information":[{"code":"Px00045010008","type":"CDM"},{"code":"33018","type":"HCPCS"}],"standard_charges":[{"gross_charge":2466.0,"discounted_cash":863.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00045010009","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":10100.0,"discounted_cash":3535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ FACIAL CDM","code_information":[{"code":"Px00045010010","type":"CDM"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT CDM","code_information":[{"code":"Px00045010011","type":"CDM"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3418.0,"discounted_cash":1196.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT CDM","code_information":[{"code":"Px00045010012","type":"CDM"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":3418.0,"discounted_cash":1196.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG CDM","code_information":[{"code":"Px00045010013","type":"CDM"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"discounted_cash":838.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR CDM","code_information":[{"code":"Px00045010014","type":"CDM"},{"code":"15738","type":"HCPCS"}],"standard_charges":[{"gross_charge":10352.0,"discounted_cash":3623.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM CDM","code_information":[{"code":"Px00045010015","type":"CDM"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":13199.0,"discounted_cash":4619.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM CDM","code_information":[{"code":"Px00045010016","type":"CDM"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":3225.0,"discounted_cash":1128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG CDM","code_information":[{"code":"Px00045010017","type":"CDM"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":2397.0,"discounted_cash":838.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES CDM","code_information":[{"code":"Px00045010018","type":"CDM"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":63.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00045010019","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES CDM","code_information":[{"code":"Px00045010020","type":"CDM"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":63.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES CDM","code_information":[{"code":"Px00045010021","type":"CDM"},{"code":"30310","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF NOSE LESION CDM","code_information":[{"code":"Px00045010023","type":"CDM"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF NASAL SEPTUM ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00045010024","type":"CDM"},{"code":"30020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":373.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE NASAL FOREIGN BODY CDM","code_information":[{"code":"Px00045010025","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ABLATE INF TURBINATE SUPERFICIAL CDM","code_information":[{"code":"Px00045010027","type":"CDM"},{"code":"30801","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED SIMPLE CDM","code_information":[{"code":"Px00045010028","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED COMPLEX CDM","code_information":[{"code":"Px00045010030","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM","code_information":[{"code":"Px00045010031","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 CDM","code_information":[{"code":"Px00045010032","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 CDM","code_information":[{"code":"Px00045010033","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION GT/4 CDM","code_information":[{"code":"Px00045010034","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045010035","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM CDM","code_information":[{"code":"Px00045010036","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM CDM","code_information":[{"code":"Px00045010037","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L GT/4.0 CM CDM","code_information":[{"code":"Px00045010038","type":"CDM"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G GT/4.0CM CDM","code_information":[{"code":"Px00045010039","type":"CDM"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM CDM","code_information":[{"code":"Px00045010040","type":"CDM"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":472.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM CDM","code_information":[{"code":"Px00045010041","type":"CDM"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TRIMMING NONDYSTROPHIC NAILS ANY NUMBER CDM","code_information":[{"code":"Px00045010042","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":156.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010043","type":"CDM"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":5136.0,"discounted_cash":1797.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010044","type":"CDM"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2006.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010045","type":"CDM"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2086.0,"discounted_cash":730.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010046","type":"CDM"},{"code":"15005","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":234.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM","code_information":[{"code":"Px00045010047","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION SINGLE TENDON ORIGIN/INSERTION CDM","code_information":[{"code":"Px00045010048","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM","code_information":[{"code":"Px00045010049","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM","code_information":[{"code":"Px00045010050","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ CDM","code_information":[{"code":"Px00045010051","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION CDM","code_information":[{"code":"Px00045010052","type":"CDM"},{"code":"21453","type":"HCPCS"}],"standard_charges":[{"gross_charge":7614.0,"discounted_cash":2664.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG CDM","code_information":[{"code":"Px00045010053","type":"CDM"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG CDM","code_information":[{"code":"Px00045010054","type":"CDM"},{"code":"25609","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERT CATH ARTERY CUTDOWN CDM","code_information":[{"code":"Px00045010055","type":"CDM"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":87.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA CDM","code_information":[{"code":"Px00045010056","type":"CDM"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER CDM","code_information":[{"code":"Px00045010057","type":"CDM"},{"code":"26235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OSTEOTOMY PHALANX FINGER EACH CDM","code_information":[{"code":"Px00045010058","type":"CDM"},{"code":"26567","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE CDM","code_information":[{"code":"Px00045010059","type":"CDM"},{"code":"26607","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE INFRAPATELLAR TENDON PRIMARY CDM","code_information":[{"code":"Px00045010063","type":"CDM"},{"code":"27380","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE CDM","code_information":[{"code":"Px00045010064","type":"CDM"},{"code":"28525","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING HIP CDM","code_information":[{"code":"Px00045010065","type":"CDM"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE CDM","code_information":[{"code":"Px00045010066","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2152.0,"discounted_cash":753.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CATHETER ASPIRATION NASOTRACHEAL SPX CDM","code_information":[{"code":"Px00045010067","type":"CDM"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING CDM","code_information":[{"code":"Px00045010068","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":500.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH CDM","code_information":[{"code":"Px00045010071","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":21529.0,"discounted_cash":7535.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR BLOOD VESSEL DIRECT LOWER EXTREMITY CDM","code_information":[{"code":"Px00045010073","type":"CDM"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTRODUCTION NEEDLE/INTRACATHETER VEIN CDM","code_information":[{"code":"Px00045010074","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM CDM","code_information":[{"code":"Px00045010076","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"discounted_cash":499.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010077","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":6927.0,"discounted_cash":2424.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010078","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":18125.0,"discounted_cash":6343.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR CDM","code_information":[{"code":"Px00045010079","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010080","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE CDM","code_information":[{"code":"Px00045010081","type":"CDM"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":166.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH CDM","code_information":[{"code":"Px00045010082","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1637.0,"discounted_cash":572.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX CDM","code_information":[{"code":"Px00045010083","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS CEREBRAL IV INFUSION CDM","code_information":[{"code":"Px00045010084","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.0,"discounted_cash":463.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE CDM","code_information":[{"code":"Px00045010086","type":"CDM"},{"code":"41007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB CDM","code_information":[{"code":"Px00045010087","type":"CDM"},{"code":"41017","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00045010088","type":"CDM"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS CORONARY INTRAVENOUS INFUSION CDM","code_information":[{"code":"Px00045010089","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.0,"discounted_cash":463.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EGD FLEXIBLE FOREIGN BODY REMOVAL CDM","code_information":[{"code":"Px00045010090","type":"CDM"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE CDM","code_information":[{"code":"Px00045010091","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.0,"discounted_cash":408.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO CDM","code_information":[{"code":"Px00045010092","type":"CDM"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045010093","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":3136.0,"discounted_cash":1097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00045010094","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":5866.0,"discounted_cash":2053.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SIGMOIDOSCOPY FLX CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010095","type":"CDM"},{"code":"45334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00045010097","type":"CDM"},{"code":"45005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00045010098","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3710.0,"discounted_cash":1298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00045010099","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":3028.0,"discounted_cash":1059.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REDUCTION OF RECTAL PROLAPSE CDM","code_information":[{"code":"Px00045010100","type":"CDM"},{"code":"45900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM","code_information":[{"code":"Px00045010101","type":"CDM"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":1424.0,"discounted_cash":498.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD CDM","code_information":[{"code":"Px00045010102","type":"CDM"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO W/SIMPLE REMOVAL STONE & STENT CDM","code_information":[{"code":"Px00045010103","type":"CDM"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":5018.0,"discounted_cash":1756.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM CDM","code_information":[{"code":"Px00045010104","type":"CDM"},{"code":"54435","type":"HCPCS"}],"standard_charges":[{"gross_charge":5050.0,"discounted_cash":1767.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX CDM","code_information":[{"code":"Px00045010105","type":"CDM"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2249.0,"discounted_cash":787.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA CDM","code_information":[{"code":"Px00045010106","type":"CDM"},{"code":"61108","type":"HCPCS"}],"standard_charges":[{"gross_charge":5584.0,"discounted_cash":1954.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM","code_information":[{"code":"Px00045010107","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":392.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID CDM","code_information":[{"code":"Px00045010108","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2587.0,"discounted_cash":905.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATE ELBOW W/ANESTH CDM","code_information":[{"code":"Px00045010109","type":"CDM"},{"code":"24300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ALCOHOL/DRUG SCREEN/INTERVENTION 15-30 MIN CDM","code_information":[{"code":"Px00045010110","type":"CDM"},{"code":"99408","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ALCOHOL/DRUG SCREEN/INTERVENTION GT/30 MIN CDM","code_information":[{"code":"Px00045010111","type":"CDM"},{"code":"99409","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NASOPHARYNGOSCOPY CDM","code_information":[{"code":"Px00045010113","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE CDM","code_information":[{"code":"Px00045010115","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":6478.0,"discounted_cash":2267.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EPISIOTOMY OR VAGINAL REPAIR CDM","code_information":[{"code":"Px00045010117","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":11815.0,"discounted_cash":4135.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED VAGINAL DELIVERY ONLY CDM","code_information":[{"code":"Px00045010118","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DELIVER PLACENTA CDM","code_information":[{"code":"Px00045010119","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":6478.0,"discounted_cash":2267.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SPONTANEOUS ABORTION FAC CDM","code_information":[{"code":"Px00045010121","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TEMP TRANSCUTANEOUS EXT PACING CDM","code_information":[{"code":"Px00045010123","type":"CDM"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":2350.0,"discounted_cash":822.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM","code_information":[{"code":"Px00045010132","type":"CDM"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":603.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS CDM","code_information":[{"code":"Px00045010134","type":"CDM"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DISTAL RADIAL FRACTURE CDM","code_information":[{"code":"Px00045010138","type":"CDM"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX PELVIC FX W/O MANIP CDM","code_information":[{"code":"Px00045010139","type":"CDM"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX PELVIC FX W/MANIP CDM","code_information":[{"code":"Px00045010140","type":"CDM"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS FEM/JUGULAR CDM","code_information":[{"code":"Px00045010143","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS SCALP VEIN CDM","code_information":[{"code":"Px00045010144","type":"CDM"},{"code":"36405","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS OTHER VEIN CDM","code_information":[{"code":"Px00045010145","type":"CDM"},{"code":"36406","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NON-ROUTINE BL DRAW GT/3 YRS CDM","code_information":[{"code":"Px00045010146","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":826.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED VEIN ACCESS CUTDOWN LT/1 YR CDM","code_information":[{"code":"Px00045010148","type":"CDM"},{"code":"36420","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED VEIN ACCESS CUTDOWN GT/1 YR CDM","code_information":[{"code":"Px00045010149","type":"CDM"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLSD CLAVICLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010152","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CORRECT HALLUX VALGUS SESAMOID CDM","code_information":[{"code":"Px00045010154","type":"CDM"},{"code":"28295","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE WRIST TENDON LESION CDM","code_information":[{"code":"Px00045010156","type":"CDM"},{"code":"25111","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT THIGH FX GROWTH PLATE CDM","code_information":[{"code":"Px00045010157","type":"CDM"},{"code":"27516","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE FRACTURE(S) TUBEROSITY CDM","code_information":[{"code":"Px00045010158","type":"CDM"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00045010159","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT KNEE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010163","type":"CDM"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5221.0,"discounted_cash":1827.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010165","type":"CDM"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT PATELLA DISLOCATION W/ANSETH CDM","code_information":[{"code":"Px00045010168","type":"CDM"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN LOWER LEG LESION DEEP CDM","code_information":[{"code":"Px00045010171","type":"CDM"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN LOWER LEG BURSA CDM","code_information":[{"code":"Px00045010172","type":"CDM"},{"code":"27604","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ACHILLES TENDON CDM","code_information":[{"code":"Px00045010173","type":"CDM"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF LEG TENDON EACH CDM","code_information":[{"code":"Px00045010174","type":"CDM"},{"code":"27664","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIB SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010176","type":"CDM"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010179","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010182","type":"CDM"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010185","type":"CDM"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INT DWELL URETERAL STENT TRANSURETHRAL CDM","code_information":[{"code":"Px00045010186","type":"CDM"},{"code":"50386","type":"HCPCS"}],"standard_charges":[{"gross_charge":4295.0,"discounted_cash":1503.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE CDM","code_information":[{"code":"Px00045010187","type":"CDM"},{"code":"27766","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX POST ANKLE FX W/O MANIP CDM","code_information":[{"code":"Px00045010189","type":"CDM"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX POST ANKLE FX W/MANIPULATION CDM","code_information":[{"code":"Px00045010190","type":"CDM"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL EXCISION BONE PHALANX TOE CDM","code_information":[{"code":"Px00045010191","type":"CDM"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP CDM","code_information":[{"code":"Px00045010192","type":"CDM"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM","code_information":[{"code":"Px00045010195","type":"CDM"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL REMOVAL OF TOE-HEMIPHALANGECTOMY OR INTERPHALANGEA CDM","code_information":[{"code":"Px00045010196","type":"CDM"},{"code":"28160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE CDM","code_information":[{"code":"Px00045010197","type":"CDM"},{"code":"27784","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010198","type":"CDM"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX CDM","code_information":[{"code":"Px00045010200","type":"CDM"},{"code":"51045","type":"HCPCS"}],"standard_charges":[{"gross_charge":4295.0,"discounted_cash":1503.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR CDM","code_information":[{"code":"Px00045010201","type":"CDM"},{"code":"63661","type":"HCPCS"}],"standard_charges":[{"gross_charge":7752.0,"discounted_cash":2713.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 1 CDM","code_information":[{"code":"Px00045010204","type":"CDM"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 2 CDM","code_information":[{"code":"Px00045010207","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":352.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 3 CDM","code_information":[{"code":"Px00045010210","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":569.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 4 CDM","code_information":[{"code":"Px00045010213","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1169.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 5 CDM","code_information":[{"code":"Px00045010216","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":5171.0,"discounted_cash":1809.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ NON-NDWELLG BLADDER CATHETER CDM","code_information":[{"code":"Px00045010219","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE ADDL 30 MIN CDM","code_information":[{"code":"Px00045010221","type":"CDM"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1772.0,"discounted_cash":620.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE CDM","code_information":[{"code":"Px00045010223","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE CYSTOSTOMY TUBE SIMPLE CDM","code_information":[{"code":"Px00045010227","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE CYSTOSTOMY TUBE COMPLICATED CDM","code_information":[{"code":"Px00045010228","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"discounted_cash":846.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00045010229","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOURETHROSCOPY CDM","code_information":[{"code":"Px00045010230","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.0,"discounted_cash":402.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX FINGER DISLOCATION CDM","code_information":[{"code":"Px00045010231","type":"CDM"},{"code":"26785","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX METATARSAL FXW W/O CDM","code_information":[{"code":"Px00045010232","type":"CDM"},{"code":"28485","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00045010233","type":"CDM"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO BLADDER W/URETERAL CATHETERIZATION CDM","code_information":[{"code":"Px00045010234","type":"CDM"},{"code":"52005","type":"HCPCS"}],"standard_charges":[{"gross_charge":5018.0,"discounted_cash":1756.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE W/INTERNAL FIXATION CDM","code_information":[{"code":"Px00045010235","type":"CDM"},{"code":"26615","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION ANES AGENT SPHENOPALATINE GANGLION CDM","code_information":[{"code":"Px00045010236","type":"CDM"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FUSION OF FINGER JOINT CDM","code_information":[{"code":"Px00045010238","type":"CDM"},{"code":"26860","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM","code_information":[{"code":"Px00045010239","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DILAT URETHRAL STRIX DILATOR MALE 1ST","code_information":[{"code":"Px00045010240","type":"CDM"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SKIN FULL GRAFT EEN & LIPS 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010242","type":"CDM"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE","code_information":[{"code":"Px00045010244","type":"CDM"},{"code":"41008","type":"HCPCS"}],"standard_charges":[{"gross_charge":4503.0,"discounted_cash":1576.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC CDM","code_information":[{"code":"Px00045010245","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DILATION XST TRC ENDOUROLOGIC PX W/O IMG CDM","code_information":[{"code":"Px00045010246","type":"CDM"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":528.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATE FINGER/THUMB SINGLE W/LOCAL ADV FLAPS CDM","code_information":[{"code":"Px00045010250","type":"CDM"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REAPPROXIMATING OF DISTAL FINGERTIP CDM","code_information":[{"code":"Px00045010251","type":"CDM"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":250.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PELVIS LESION CDM","code_information":[{"code":"Px00045010252","type":"CDM"},{"code":"26990","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE HIP FOREIGN BODY CDM","code_information":[{"code":"Px00045010254","type":"CDM"},{"code":"27087","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT COCCYGEAL FRACTURE CDM","code_information":[{"code":"Px00045010255","type":"CDM"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HIP SOCKET FRACTURE CDM","code_information":[{"code":"Px00045010256","type":"CDM"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX THIGH FRACTURE PROX END NECK W/O MANIP CDM","code_information":[{"code":"Px00045010257","type":"CDM"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM","code_information":[{"code":"Px00045010258","type":"CDM"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX GREATER TROCHANTERIC FX W/O MANJ CDM","code_information":[{"code":"Px00045010259","type":"CDM"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX HIP DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010263","type":"CDM"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010267","type":"CDM"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":5221.0,"discounted_cash":1827.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX SPONTANEOUS HIP DISLOCATION BY ABDUCTION W/O ANESTH W/O MANIP CDM","code_information":[{"code":"Px00045010269","type":"CDM"},{"code":"27256","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010271","type":"CDM"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010275","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00045010276","type":"CDM"},{"code":"27086","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX THIGH FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010278","type":"CDM"},{"code":"27240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2086.0,"discounted_cash":730.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NEG PRESSURE WOUND THERAPY UTILIZING DME 50 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010279","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":266.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX CDM","code_information":[{"code":"Px00045010280","type":"CDM"},{"code":"20650","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED RX ACETABULAR FX MANIPULATION CDM","code_information":[{"code":"Px00045010281","type":"CDM"},{"code":"27222","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT CDM","code_information":[{"code":"Px00045010282","type":"CDM"},{"code":"62252","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":199.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE TENDON SHEATH DIGIT&/PALM EACH CDM","code_information":[{"code":"Px00045010283","type":"CDM"},{"code":"26020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX FINGER FRACTURE W/PERC FIXATION W/MANIP EACH CDM","code_information":[{"code":"Px00045010284","type":"CDM"},{"code":"26727","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION CDM","code_information":[{"code":"Px00045010285","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":5853.0,"discounted_cash":2048.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY DEEP THIGH/KNEE CDM","code_information":[{"code":"Px00045010286","type":"CDM"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":5853.0,"discounted_cash":2048.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT FEMORAL SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010289","type":"CDM"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI CDM","code_information":[{"code":"Px00045010290","type":"CDM"},{"code":"54430","type":"HCPCS"}],"standard_charges":[{"gross_charge":8100.0,"discounted_cash":2835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX OF LUNATE DISLOCATION CDM","code_information":[{"code":"Px00045010291","type":"CDM"},{"code":"25695","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE SUPRACNDLR W/O MANIP CDM","code_information":[{"code":"Px00045010292","type":"CDM"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010294","type":"CDM"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":5584.0,"discounted_cash":1954.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE W/WO TRACTION CDM","code_information":[{"code":"Px00045010295","type":"CDM"},{"code":"27503","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1169.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FEMORAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010297","type":"CDM"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE FRACTURE PROXIMAL TIBIAL W/MANIP CDM","code_information":[{"code":"Px00045010299","type":"CDM"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM","code_information":[{"code":"Px00045010300","type":"CDM"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":2563.0,"discounted_cash":897.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PLACEMENT SETON CDM","code_information":[{"code":"Px00045010301","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REM PILONIDAL CYST EXTENSIVE CDM","code_information":[{"code":"Px00045010302","type":"CDM"},{"code":"11771","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ADJ TISS TRS S/A/L DEF 10SQCM CDM","code_information":[{"code":"Px00045010303","type":"CDM"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":4230.0,"discounted_cash":1480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APL SKIN SUB HI TAL 1ST 25CM CDM","code_information":[{"code":"Px00045010304","type":"CDM"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APL SKIN SUB HI TAL PED ADL100 CDM","code_information":[{"code":"Px00045010305","type":"CDM"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PEDICLE FLAP EL NOSE EAR LIPS CDM","code_information":[{"code":"Px00045010306","type":"CDM"},{"code":"15576","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERT NON-TUNNEL CV CATH LT/5 YR CDM","code_information":[{"code":"Px00045010307","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":12046.0,"discounted_cash":4216.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERT NEEDLE BONE CAVITY CDM","code_information":[{"code":"Px00045010308","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM","code_information":[{"code":"Px00045010309","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM","code_information":[{"code":"Px00045010310","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PILONIDAL CYST SIMPLE CDM","code_information":[{"code":"Px00045010311","type":"CDM"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PILONIDAL CYST COMPLICATED CDM","code_information":[{"code":"Px00045010312","type":"CDM"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY SIMPLE CDM","code_information":[{"code":"Px00045010313","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY COMPLICATED CDM","code_information":[{"code":"Px00045010314","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FOREHEAD FLAP W VASC PEDICLE CDM","code_information":[{"code":"Px00045010315","type":"CDM"},{"code":"15731","type":"HCPCS"}],"standard_charges":[{"gross_charge":10352.0,"discounted_cash":3623.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF HEMA/FLUID CDM","code_information":[{"code":"Px00045010316","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COMPLEX DRAINAGE WOUND - CMPLX CDM","code_information":[{"code":"Px00045010317","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":5853.0,"discounted_cash":2048.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00045010318","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN ADD-ON CDM","code_information":[{"code":"Px00045010319","type":"CDM"},{"code":"11001","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE SKIN AT FX SITE CDM","code_information":[{"code":"Px00045010320","type":"CDM"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEB SKIN BONE AT FX SITE CDM","code_information":[{"code":"Px00045010321","type":"CDM"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":5853.0,"discounted_cash":2048.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM","code_information":[{"code":"Px00045010324","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.0,"discounted_cash":502.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEB MUSC/FASCIA 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010325","type":"CDM"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY PLANNED SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045010326","type":"CDM"},{"code":"31600","type":"HCPCS"}],"standard_charges":[{"gross_charge":8066.0,"discounted_cash":2823.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEB BONE 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010327","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT NASAL SEPTAL FRACTURE CDM","code_information":[{"code":"Px00045010328","type":"CDM"},{"code":"21337","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEB MUSC/FASCIA ADD-ON CDM","code_information":[{"code":"Px00045010329","type":"CDM"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT BONE EACH ADDL 20 SQ CM","code_information":[{"code":"Px00045010330","type":"CDM"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SKIN TAGS CDM","code_information":[{"code":"Px00045010331","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SKIN TAGS ADD-ON CDM","code_information":[{"code":"Px00045010332","type":"CDM"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM","code_information":[{"code":"Px00045010333","type":"CDM"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM","code_information":[{"code":"Px00045010334","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM CDM","code_information":[{"code":"Px00045010335","type":"CDM"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045010336","type":"CDM"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM CDM","code_information":[{"code":"Px00045010337","type":"CDM"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM CDM","code_information":[{"code":"Px00045010338","type":"CDM"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM CDM","code_information":[{"code":"Px00045010344","type":"CDM"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM CDM","code_information":[{"code":"Px00045010345","type":"CDM"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE NAIL 1-5 CDM","code_information":[{"code":"Px00045010346","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE NAIL 6 OR MORE CDM","code_information":[{"code":"Px00045010347","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF NAIL PLATE CDM","code_information":[{"code":"Px00045010348","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE NAIL PLATE ADD-ON CDM","code_information":[{"code":"Px00045010349","type":"CDM"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF NAIL BED CDM","code_information":[{"code":"Px00045010351","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF NAIL BED CDM","code_information":[{"code":"Px00045010353","type":"CDM"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION OF NAIL FOLD TOE CDM","code_information":[{"code":"Px00045010354","type":"CDM"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM","code_information":[{"code":"Px00045010355","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM","code_information":[{"code":"Px00045010356","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM CDM","code_information":[{"code":"Px00045010357","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SPRFCL WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN TRNK EXTR H CDM","code_information":[{"code":"Px00045010358","type":"CDM"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SPRFCL WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TRNK EXTR HND CDM","code_information":[{"code":"Px00045010359","type":"CDM"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S)GT/30CM SLP NK AX EXGEN TRNK EXTR CDM","code_information":[{"code":"Px00045010360","type":"CDM"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010361","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 2.6-5.0CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00045010362","type":"CDM"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 5.1-7.5CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00045010363","type":"CDM"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 7.6-12.5CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010364","type":"CDM"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 12.6-20.0CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010365","type":"CDM"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISE EXCESSIVE SKN TISS OTHR CDM","code_information":[{"code":"Px00045010366","type":"CDM"},{"code":"15839","type":"HCPCS"}],"standard_charges":[{"gross_charge":5688.0,"discounted_cash":1990.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 20.1-30.0CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010367","type":"CDM"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) GT/30.0 CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010369","type":"CDM"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM","code_information":[{"code":"Px00045010370","type":"CDM"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSURE OF SPLIT WOUND W/PACKNG CDM","code_information":[{"code":"Px00045010371","type":"CDM"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM","code_information":[{"code":"Px00045010372","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00045010373","type":"CDM"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00045010374","type":"CDM"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010375","type":"CDM"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00045010376","type":"CDM"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT GT/30 CM CDM","code_information":[{"code":"Px00045010377","type":"CDM"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":4230.0,"discounted_cash":1480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM","code_information":[{"code":"Px00045010378","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":298.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REM FIX DEV ANOTHER PHYSICIAN CDM","code_information":[{"code":"Px00045010379","type":"CDM"},{"code":"20665","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00045010380","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00045010381","type":"CDM"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010382","type":"CDM"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 20.1-30.0CM CDM","code_information":[{"code":"Px00045010383","type":"CDM"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT GT/30.0CM CDM","code_information":[{"code":"Px00045010384","type":"CDM"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.0,"discounted_cash":1626.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM LT/2.5 CM CDM","code_information":[{"code":"Px00045010385","type":"CDM"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM","code_information":[{"code":"Px00045010386","type":"CDM"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM","code_information":[{"code":"Px00045010387","type":"CDM"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM","code_information":[{"code":"Px00045010388","type":"CDM"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010389","type":"CDM"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00045010390","type":"CDM"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM GT/30CM CDM","code_information":[{"code":"Px00045010391","type":"CDM"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010392","type":"CDM"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010393","type":"CDM"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON EA ADD 5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010394","type":"CDM"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010395","type":"CDM"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010396","type":"CDM"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REM EXTNL FIX DEV W ANES CDM","code_information":[{"code":"Px00045010397","type":"CDM"},{"code":"20694","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON 5CM OR LESS COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010398","type":"CDM"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":210.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM CDM","code_information":[{"code":"Px00045010399","type":"CDM"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT CDM","code_information":[{"code":"Px00045010401","type":"CDM"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SERIAL TONOMETRY EXAM(S) CDM","code_information":[{"code":"Px00045010402","type":"CDM"},{"code":"92100","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY CDM","code_information":[{"code":"Px00045010404","type":"CDM"},{"code":"33020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2466.0,"discounted_cash":863.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE RECTAL OBSTRUCTION W GEN ANESTH CDM","code_information":[{"code":"Px00045010405","type":"CDM"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX CDM","code_information":[{"code":"Px00045010407","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF ANAL ABSCESS CDM","code_information":[{"code":"Px00045010409","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00045010410","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EXT HEM GROUPS 2 OR MORE CDM","code_information":[{"code":"Px00045010412","type":"CDM"},{"code":"46250","type":"HCPCS"}],"standard_charges":[{"gross_charge":6031.0,"discounted_cash":2110.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF HEMORRHOID CLOT CDM","code_information":[{"code":"Px00045010413","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045010414","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY REMOVE FOR BODY CDM","code_information":[{"code":"Px00045010415","type":"CDM"},{"code":"46608","type":"HCPCS"}],"standard_charges":[{"gross_charge":2225.0,"discounted_cash":778.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010416","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":2906.0,"discounted_cash":1017.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE BY LIGAT INT HEM GRP CDM","code_information":[{"code":"Px00045010417","type":"CDM"},{"code":"46945","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSTOMY CYSTOTOMY W DRAINAGE CDM","code_information":[{"code":"Px00045010419","type":"CDM"},{"code":"51040","type":"HCPCS"}],"standard_charges":[{"gross_charge":4295.0,"discounted_cash":1503.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLADDER BY NEEDLE CDM","code_information":[{"code":"Px00045010420","type":"CDM"},{"code":"51100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLADDER BY TROCAR/CATH CDM","code_information":[{"code":"Px00045010421","type":"CDM"},{"code":"51101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":466.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REV EYELID LAT CDM","code_information":[{"code":"Px00045010422","type":"CDM"},{"code":"21282","type":"HCPCS"}],"standard_charges":[{"gross_charge":5369.0,"discounted_cash":1879.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00045010423","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERT BLADDER CATH COMPLEX CDM","code_information":[{"code":"Px00045010424","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX FX ORBIT CLSD W MANIP CDM","code_information":[{"code":"Px00045010425","type":"CDM"},{"code":"21401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT STRICTURE/DILATION CDM","code_information":[{"code":"Px00045010426","type":"CDM"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":5018.0,"discounted_cash":1756.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF URETHRA CDM","code_information":[{"code":"Px00045010427","type":"CDM"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3885.0,"discounted_cash":1359.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF URETHRA ABSCESS CDM","code_information":[{"code":"Px00045010428","type":"CDM"},{"code":"53060","type":"HCPCS"}],"standard_charges":[{"gross_charge":3885.0,"discounted_cash":1359.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CL TX PALTL/MAXLRY FX WID WFIX CDM","code_information":[{"code":"Px00045010429","type":"CDM"},{"code":"21421","type":"HCPCS"}],"standard_charges":[{"gross_charge":5369.0,"discounted_cash":1879.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DILATE URETHRA STRICTURE W/ FILIFORM MALE INITIAL CDM","code_information":[{"code":"Px00045010430","type":"CDM"},{"code":"53620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":492.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DILATION OF URETHRA FEMALE INITIAL CDM","code_information":[{"code":"Px00045010431","type":"CDM"},{"code":"53660","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SLITTING OF PREPUCE EXCEPT NEWBORN CDM","code_information":[{"code":"Px00045010432","type":"CDM"},{"code":"54001","type":"HCPCS"}],"standard_charges":[{"gross_charge":4421.0,"discounted_cash":1547.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM","code_information":[{"code":"Px00045010433","type":"CDM"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00045010434","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REDUCE TESTIS TORSION CDM","code_information":[{"code":"Px00045010435","type":"CDM"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":5050.0,"discounted_cash":1767.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00045010436","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":4421.0,"discounted_cash":1547.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM ABSCESS CDM","code_information":[{"code":"Px00045010437","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SCROTUM LESION CDM","code_information":[{"code":"Px00045010438","type":"CDM"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3885.0,"discounted_cash":1359.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I & D OF VULVA/PERINEUM CDM","code_information":[{"code":"Px00045010440","type":"CDM"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF GLAND ABSCESS CDM","code_information":[{"code":"Px00045010441","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SURGERY FOR VULVA LESION CDM","code_information":[{"code":"Px00045010442","type":"CDM"},{"code":"56440","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PELVIC FLUID CDM","code_information":[{"code":"Px00045010443","type":"CDM"},{"code":"57020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6608.0,"discounted_cash":2312.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00045010444","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF VAGINA SUTURE CDM","code_information":[{"code":"Px00045010445","type":"CDM"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":9834.0,"discounted_cash":3441.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR VAGINA/PERINEUM CDM","code_information":[{"code":"Px00045010446","type":"CDM"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PELVIC EXAMINATION CDM","code_information":[{"code":"Px00045010447","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE VAGINAL FOREIGN BODY CDM","code_information":[{"code":"Px00045010448","type":"CDM"},{"code":"57415","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045010450","type":"CDM"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF CERVIX CDM","code_information":[{"code":"Px00045010451","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.0,"discounted_cash":547.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00045010452","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCSN EXTNSOR TNDN SHEATH WRST CDM","code_information":[{"code":"Px00045010453","type":"CDM"},{"code":"25000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DILATION AND CURETTAGE CDM","code_information":[{"code":"Px00045010454","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00045010455","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRILL SKULL FOR IMPLANTATION CDM","code_information":[{"code":"Px00045010456","type":"CDM"},{"code":"61107","type":"HCPCS"}],"standard_charges":[{"gross_charge":6980.0,"discounted_cash":2443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PIERCE SKULL & REMOVE CLOT CDM","code_information":[{"code":"Px00045010457","type":"CDM"},{"code":"61154","type":"HCPCS"}],"standard_charges":[{"gross_charge":5584.0,"discounted_cash":1954.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PIERCE SKULL IMPLANT DEVICE CDM","code_information":[{"code":"Px00045010458","type":"CDM"},{"code":"61210","type":"HCPCS"}],"standard_charges":[{"gross_charge":6980.0,"discounted_cash":2443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ TRIGEMINAL CDM","code_information":[{"code":"Px00045010459","type":"CDM"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ OCCIPITAL CDM","code_information":[{"code":"Px00045010461","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ INTERCOSTAL SINGLE CDM","code_information":[{"code":"Px00045010462","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":482.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REV FNGR JNT EA CDM","code_information":[{"code":"Px00045010463","type":"CDM"},{"code":"26140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REM IMPLANT FINGER OR HAND CDM","code_information":[{"code":"Px00045010464","type":"CDM"},{"code":"26320","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ PLANTAR DIGIT CDM","code_information":[{"code":"Px00045010465","type":"CDM"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF DIGIT NERVE CDM","code_information":[{"code":"Px00045010466","type":"CDM"},{"code":"64831","type":"HCPCS"}],"standard_charges":[{"gross_charge":2563.0,"discounted_cash":897.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM","code_information":[{"code":"Px00045010467","type":"CDM"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":423.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE EMBEDDED CDM","code_information":[{"code":"Px00045010469","type":"CDM"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":280.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/O SLIT LAMP CDM","code_information":[{"code":"Px00045010471","type":"CDM"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":423.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF EYE WOUND CDM","code_information":[{"code":"Px00045010474","type":"CDM"},{"code":"65270","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":1729.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00045010475","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"discounted_cash":503.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA W/ APPLICATION OF CHELATING AGENT CDM","code_information":[{"code":"Px00045010477","type":"CDM"},{"code":"65436","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":1729.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CORNEA CDM","code_information":[{"code":"Px00045010479","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":1729.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REVISE EYE SOCKET IMPLANT CDM","code_information":[{"code":"Px00045010480","type":"CDM"},{"code":"67560","type":"HCPCS"}],"standard_charges":[{"gross_charge":5765.0,"discounted_cash":2017.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYELID ABSCESS CDM","code_information":[{"code":"Px00045010482","type":"CDM"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF EYELID FOLD CDM","code_information":[{"code":"Px00045010483","type":"CDM"},{"code":"67715","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":1729.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EYELID FOREIGN BODY CDM","code_information":[{"code":"Px00045010484","type":"CDM"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":423.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN EXTERNAL EAR LESION SIMPLE CDM","code_information":[{"code":"Px00045010485","type":"CDM"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN EXTERNAL EAR LESION COMPLICATED CDM","code_information":[{"code":"Px00045010487","type":"CDM"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045010489","type":"CDM"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM","code_information":[{"code":"Px00045010491","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF GUM LESION CDM","code_information":[{"code":"Px00045010492","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION FEMORAL CDM","code_information":[{"code":"Px00045010493","type":"CDM"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF DISTAL END FEMOR FRACTURE CDM","code_information":[{"code":"Px00045010494","type":"CDM"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":5221.0,"discounted_cash":1827.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT PATELLAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010496","type":"CDM"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REP ET HAND W FG EA TENDON CDM","code_information":[{"code":"Px00045010497","type":"CDM"},{"code":"26412","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DECOMP ANT LAT LEG ONLY CDM","code_information":[{"code":"Px00045010498","type":"CDM"},{"code":"27600","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIBIAL FRACTURE PROXIMAL W/O MANIP CDM","code_information":[{"code":"Px00045010499","type":"CDM"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND/LESION 2.6-7.5CM CMPLX FRHD CKS SHN MTH NK AX CDM","code_information":[{"code":"Px00045010501","type":"CDM"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WND/LESION ADD-ON 5CM CMPLX FRHD CKS SHN MTH NK AX GEN HND CDM","code_information":[{"code":"Px00045010502","type":"CDM"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010504","type":"CDM"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010505","type":"CDM"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":453.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON 5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010506","type":"CDM"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LATE CLOSURE OF WOUND EXTENSIVE OR COMPLICATED CDM","code_information":[{"code":"Px00045010507","type":"CDM"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4230.0,"discounted_cash":1480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM","code_information":[{"code":"Px00045010508","type":"CDM"},{"code":"67028","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":510.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM OR LESS CDM","code_information":[{"code":"Px00045010509","type":"CDM"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":6420.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SKIN TISSUE REARRANGEMENT 10 SQ CM OR LESS EYLDS NS ERS LIP CDM","code_information":[{"code":"Px00045010510","type":"CDM"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":6420.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FILLETED FINGER/TOE FLAP CDM","code_information":[{"code":"Px00045010511","type":"CDM"},{"code":"14350","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.0,"discounted_cash":1626.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SKIN PINCH GRAFT 2 CM DIAMETER CDM","code_information":[{"code":"Px00045010512","type":"CDM"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SKN SPLT A-GRFT FAC/NCK/HF/G 1ST 100 SQ CM CDM","code_information":[{"code":"Px00045010513","type":"CDM"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":13199.0,"discounted_cash":4619.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010514","type":"CDM"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6420.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COMPOSITE SKIN GRAFT EAR NASAL ALA CDM","code_information":[{"code":"Px00045010515","type":"CDM"},{"code":"15760","type":"HCPCS"}],"standard_charges":[{"gross_charge":6420.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DERMA-FAT-FASCIA GRAFT CDM","code_information":[{"code":"Px00045010516","type":"CDM"},{"code":"15770","type":"HCPCS"}],"standard_charges":[{"gross_charge":10352.0,"discounted_cash":3623.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY BONE OPEN SUPERFICIAL CDM","code_information":[{"code":"Px00045010517","type":"CDM"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX CDM","code_information":[{"code":"Px00045010518","type":"CDM"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN S LT/5% TBSA CDM","code_information":[{"code":"Px00045010519","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM","code_information":[{"code":"Px00045010520","type":"CDM"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN L GT/10% TBSA CDM","code_information":[{"code":"Px00045010521","type":"CDM"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF BURN SCAB INITI CDM","code_information":[{"code":"Px00045010522","type":"CDM"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRESSING CHANGE UNDER ANESTHESIA CDM","code_information":[{"code":"Px00045010523","type":"CDM"},{"code":"15852","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION OF SKIN LESIONS LESS THAN 10 SQ CM CDM","code_information":[{"code":"Px00045010524","type":"CDM"},{"code":"17106","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CHEMICAL CAUTERY TISSUE CDM","code_information":[{"code":"Px00045010525","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF BREAST LESION CDM","code_information":[{"code":"Px00045010527","type":"CDM"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00045010530","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00045010531","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":4230.0,"discounted_cash":1480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00045010532","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":4230.0,"discounted_cash":1480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00045010533","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY MUSC SIMP CDM","code_information":[{"code":"Px00045010534","type":"CDM"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00045010535","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":4083.0,"discounted_cash":1429.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THER INJECTION CARP TUNNEL CDM","code_information":[{"code":"Px00045010536","type":"CDM"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ TENDON SHEATH/LIGAMENT CDM","code_information":[{"code":"Px00045010538","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ TRIGGER POINT 1/2 MUSCL CDM","code_information":[{"code":"Px00045010539","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION SINGLE/MLT TRIGGER POINT 3/GT MUSCLES CDM","code_information":[{"code":"Px00045010540","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLY/REMOVE FIXATION DEVICE CRANIAL CDM","code_information":[{"code":"Px00045010541","type":"CDM"},{"code":"20660","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HEAD BRACE CDM","code_information":[{"code":"Px00045010542","type":"CDM"},{"code":"20661","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1169.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SUPPORT IMPLANT CDM","code_information":[{"code":"Px00045010543","type":"CDM"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00045010544","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SHOULDER FOREIGN BODY CDM","code_information":[{"code":"Px00045010546","type":"CDM"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF NOSE FRACTURE W/ STABILIZATION CDM","code_information":[{"code":"Px00045010547","type":"CDM"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":6755.0,"discounted_cash":2364.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT OF NOSE FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010548","type":"CDM"},{"code":"21325","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT NASAL SEPTAL FRACTURE W/WO STABILIZATION CDM","code_information":[{"code":"Px00045010549","type":"CDM"},{"code":"21336","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION CDM","code_information":[{"code":"Px00045010550","type":"CDM"},{"code":"21400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT DENTAL RIDGE FRACTURE CDM","code_information":[{"code":"Px00045010552","type":"CDM"},{"code":"21440","type":"HCPCS"}],"standard_charges":[{"gross_charge":7679.0,"discounted_cash":2687.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT DENTAL RIDGE FRACTURE CDM","code_information":[{"code":"Px00045010553","type":"CDM"},{"code":"21445","type":"HCPCS"}],"standard_charges":[{"gross_charge":8418.0,"discounted_cash":2946.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LOWER JAW FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010554","type":"CDM"},{"code":"21450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LOWER JAW FRACTURE W/ MANIPULATION CDM","code_information":[{"code":"Px00045010555","type":"CDM"},{"code":"21451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RESET DISLOCATED JAW UNCOMPLICATED CDM","code_information":[{"code":"Px00045010556","type":"CDM"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN NECK/CHEST LESION - LESION DRAIN CDM","code_information":[{"code":"Px00045010557","type":"CDM"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":5853.0,"discounted_cash":2048.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00045010560","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1446.0,"discounted_cash":506.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00045010562","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00045010563","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC CDM","code_information":[{"code":"Px00045010564","type":"CDM"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":472.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010566","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM CDM","code_information":[{"code":"Px00045010568","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX CLAVICULAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010569","type":"CDM"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010571","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION W/O MANI CDM","code_information":[{"code":"Px00045010572","type":"CDM"},{"code":"23520","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010574","type":"CDM"},{"code":"23525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MAN CDM","code_information":[{"code":"Px00045010576","type":"CDM"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010578","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM","code_information":[{"code":"Px00045010579","type":"CDM"},{"code":"23545","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER BLADE FX W/O MANIP CDM","code_information":[{"code":"Px00045010581","type":"CDM"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER BLADE FX W/MANIP CDM","code_information":[{"code":"Px00045010583","type":"CDM"},{"code":"23575","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010585","type":"CDM"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010587","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":460.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010588","type":"CDM"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE TUBEROSITY W/O MAN CDM","code_information":[{"code":"Px00045010590","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE TUBEROSITY W/MAN CDM","code_information":[{"code":"Px00045010592","type":"CDM"},{"code":"23625","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010594","type":"CDM"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM","code_information":[{"code":"Px00045010596","type":"CDM"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ CDM","code_information":[{"code":"Px00045010598","type":"CDM"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISLOCATION/FRACTURE W/SURG NK FX CDM","code_information":[{"code":"Px00045010600","type":"CDM"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHOULDER SURGERY PROCEDURE CDM","code_information":[{"code":"Px00045010601","type":"CDM"},{"code":"23929","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":250.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF ARM LESION CDM","code_information":[{"code":"Px00045010602","type":"CDM"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF ARM BURSA CDM","code_information":[{"code":"Px00045010604","type":"CDM"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":5272.0,"discounted_cash":1845.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF ARM FOREIGN BODY CDM","code_information":[{"code":"Px00045010606","type":"CDM"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCT PREMALG LESION FIRST LESION CDM","code_information":[{"code":"Px00045010608","type":"CDM"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLOOD FROM UNDER NAIL CDM","code_information":[{"code":"Px00045010609","type":"CDM"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF BREAST IMPLANT CDM","code_information":[{"code":"Px00045010610","type":"CDM"},{"code":"19328","type":"HCPCS"}],"standard_charges":[{"gross_charge":5484.0,"discounted_cash":1919.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010611","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF NOSE FRACTURE W/O STABILIZATION CDM","code_information":[{"code":"Px00045010612","type":"CDM"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1169.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ ILIOINGUINAL CDM","code_information":[{"code":"Px00045010617","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":482.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF CONTRACEPTIVE CAP CDM","code_information":[{"code":"Px00045010618","type":"CDM"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":472.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SUPPORT IMPLANT CDM","code_information":[{"code":"Px00045010619","type":"CDM"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MUSCLES OF HAND CDM","code_information":[{"code":"Px00045010620","type":"CDM"},{"code":"26591","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION CDM","code_information":[{"code":"Px00045010621","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010622","type":"CDM"},{"code":"27257","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORATION OF KNEE JOINT CDM","code_information":[{"code":"Px00045010623","type":"CDM"},{"code":"27310","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF FIGURE EIGHT CDM","code_information":[{"code":"Px00045010624","type":"CDM"},{"code":"29049","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION CDM","code_information":[{"code":"Px00045010626","type":"CDM"},{"code":"35188","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.0,"discounted_cash":2417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND CDM","code_information":[{"code":"Px00045010627","type":"CDM"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":1729.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION EPIDURAL BLOOD/CLOT PATCH CDM","code_information":[{"code":"Px00045010629","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":365.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES CDM","code_information":[{"code":"Px00045010631","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2639.0,"discounted_cash":923.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010632","type":"CDM"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":20562.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW FRACTURE CDM","code_information":[{"code":"Px00045010633","type":"CDM"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00045010634","type":"CDM"},{"code":"25545","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FX RAD EXTRA-ARTICUL CDM","code_information":[{"code":"Px00045010635","type":"CDM"},{"code":"25607","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND TENDON CDM","code_information":[{"code":"Px00045010636","type":"CDM"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED HAND TENDON RECONSTRUCTION CDM","code_information":[{"code":"Px00045010637","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS CDM","code_information":[{"code":"Px00045010638","type":"CDM"},{"code":"27792","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX BIMALLEOLAR ANKLE FRACTURE CDM","code_information":[{"code":"Px00045010639","type":"CDM"},{"code":"27814","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX TRIMALLEOLAR ANKLE FX WO FIX PST LIP CDM","code_information":[{"code":"Px00045010640","type":"CDM"},{"code":"27822","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CORRECTION OF BUNION CDM","code_information":[{"code":"Px00045010641","type":"CDM"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING CDM","code_information":[{"code":"Px00045010642","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":6711.0,"discounted_cash":2348.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE ANAL FIST INTER CDM","code_information":[{"code":"Px00045010644","type":"CDM"},{"code":"46275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDOPEXY BY STAPLING CDM","code_information":[{"code":"Px00045010645","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM","code_information":[{"code":"Px00045010647","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":8214.0,"discounted_cash":2874.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY REMOVAL OF CLOTS CDM","code_information":[{"code":"Px00045010648","type":"CDM"},{"code":"52001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":2065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT CDM","code_information":[{"code":"Px00045010649","type":"CDM"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":2065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CERVIX 57720 CDM","code_information":[{"code":"Px00045010650","type":"CDM"},{"code":"57720","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SHOULDER FB DEEP CDM","code_information":[{"code":"Px00045010656","type":"CDM"},{"code":"23333","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF NASAL SEPTUM CDM","code_information":[{"code":"Px00045010659","type":"CDM"},{"code":"30520","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045010660","type":"CDM"},{"code":"15851","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.0,"discounted_cash":1626.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ARM/LEG NERVE CDM","code_information":[{"code":"Px00045010661","type":"CDM"},{"code":"64857","type":"HCPCS"}],"standard_charges":[{"gross_charge":9738.0,"discounted_cash":3408.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CDM","code_information":[{"code":"Px00045010662","type":"CDM"},{"code":"65235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3561.0,"discounted_cash":1246.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYE CDM","code_information":[{"code":"Px00045010663","type":"CDM"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3561.0,"discounted_cash":1246.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EYE EXAM NEW PATIENT CDM","code_information":[{"code":"Px00045010664","type":"CDM"},{"code":"92002","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":76.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED HYMENOTOMY SIMPLE INCISION CDM","code_information":[{"code":"Px00045010665","type":"CDM"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RECONSTRUCTION OF NAIL BED W/GRAFT CDM","code_information":[{"code":"Px00045010667","type":"CDM"},{"code":"11762","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.0,"discounted_cash":1626.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE ANAL FIST SUBQ CDM","code_information":[{"code":"Px00045010668","type":"CDM"},{"code":"46270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF TIBIA FRACTURE CDM","code_information":[{"code":"Px00045010669","type":"CDM"},{"code":"27756","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED MNPJ OF TMJ W/ANESTH CDM","code_information":[{"code":"Px00045010670","type":"CDM"},{"code":"21073","type":"HCPCS"}],"standard_charges":[{"gross_charge":3245.0,"discounted_cash":1135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX VERT FX W/MANJ CDM","code_information":[{"code":"Px00045010671","type":"CDM"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045010673","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":491.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FOREARM TENDON/MUSCLE SECONDARY CDM","code_information":[{"code":"Px00045010674","type":"CDM"},{"code":"25263","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPLANTATION DIGIT COMPLETE CDM","code_information":[{"code":"Px00045010675","type":"CDM"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":4856.0,"discounted_cash":1699.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED HYPOTHERMIA ILL NEONATE CDM","code_information":[{"code":"Px00045010676","type":"CDM"},{"code":"99184","type":"HCPCS"}],"standard_charges":[{"gross_charge":5234.0,"discounted_cash":1831.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND FULL THICKNESS CDM","code_information":[{"code":"Px00045010677","type":"CDM"},{"code":"67935","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":1729.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE IMPACTED EAR WAX UNI CDM","code_information":[{"code":"Px00045010678","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF SHOULDER CAST-PLASTER CDM","code_information":[{"code":"Px00045010679","type":"CDM"},{"code":"29058","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD PUSH TRANSFUSE LT 2 YR CDM","code_information":[{"code":"Px00045010680","type":"CDM"},{"code":"36440","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANI CDM","code_information":[{"code":"Px00045010681","type":"CDM"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION CDM","code_information":[{"code":"Px00045010682","type":"CDM"},{"code":"41015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY W/OPER SCOPE CDM","code_information":[{"code":"Px00045010683","type":"CDM"},{"code":"31526","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ESCHAROTOMY ADDL INCISION CDM","code_information":[{"code":"Px00045010684","type":"CDM"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":3717.0,"discounted_cash":1300.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00045010685","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":8629.0,"discounted_cash":3020.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISE/DRAIN TEAR GLAND CDM","code_information":[{"code":"Px00045010686","type":"CDM"},{"code":"68400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"discounted_cash":503.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OF NECK ARTERY CDM","code_information":[{"code":"Px00045010687","type":"CDM"},{"code":"37615","type":"HCPCS"}],"standard_charges":[{"gross_charge":5739.0,"discounted_cash":2008.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL REMOVAL FINGER BONE CDM","code_information":[{"code":"Px00045010688","type":"CDM"},{"code":"26236","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND TENDON NO MAN LND-PRIMARY CDM","code_information":[{"code":"Px00045010689","type":"CDM"},{"code":"26356","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR PALATE CDM","code_information":[{"code":"Px00045010690","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":7614.0,"discounted_cash":2664.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REVISE FINGER JOINT CDM","code_information":[{"code":"Px00045010691","type":"CDM"},{"code":"26535","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE-PERC SK FIXATION CDM","code_information":[{"code":"Px00045010692","type":"CDM"},{"code":"26608","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT THIGH FRACTURE-CLS FEM NCK W/MAN CDM","code_information":[{"code":"Px00045010693","type":"CDM"},{"code":"27232","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE-2ND TRIM CDM","code_information":[{"code":"Px00045010694","type":"CDM"},{"code":"59821","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SKIN TISSUE REARRANGEMENT 10.1 SQ CM TO 30.0 SQ CM FRHD CK CDM","code_information":[{"code":"Px00045010695","type":"CDM"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":6420.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISIONAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010696","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":542.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010697","type":"CDM"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":271.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM","code_information":[{"code":"Px00045010698","type":"CDM"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":472.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM CDM","code_information":[{"code":"Px00045010699","type":"CDM"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":472.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE ASPIRATION CYST BREAST CDM","code_information":[{"code":"Px00045010700","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF ARM FOREIGN BODY ARM/ELBOW CDM","code_information":[{"code":"Px00045010701","type":"CDM"},{"code":"24201","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA CDM","code_information":[{"code":"Px00045010702","type":"CDM"},{"code":"27635","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ARM TENDON/MUSCLE CDM","code_information":[{"code":"Px00045010704","type":"CDM"},{"code":"24341","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FX W/O MANIP CDM","code_information":[{"code":"Px00045010705","type":"CDM"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING UNNA BOOT CDM","code_information":[{"code":"Px00045010706","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED WEDGING CAST EXCEPT CLUBFOOT CASTS CDM","code_information":[{"code":"Px00045010708","type":"CDM"},{"code":"29740","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FX W/MANIP CDM","code_information":[{"code":"Px00045010709","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX CDM","code_information":[{"code":"Px00045010712","type":"CDM"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":14778.0,"discounted_cash":5172.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010713","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH CDM","code_information":[{"code":"Px00045010714","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":325.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLLECTION CAPILLARY BLOOD SPECIMEN CDM","code_information":[{"code":"Px00045010716","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010717","type":"CDM"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CATHJ UMBILICAL VEIN DX/THER NB CDM","code_information":[{"code":"Px00045010718","type":"CDM"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"discounted_cash":658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPLCMT CATH CTR VAD SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045010720","type":"CDM"},{"code":"36578","type":"HCPCS"}],"standard_charges":[{"gross_charge":6087.0,"discounted_cash":2130.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION HUMERAL CDM","code_information":[{"code":"Px00045010721","type":"CDM"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS EPICOND FRACTURE CDM","code_information":[{"code":"Px00045010722","type":"CDM"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RMVL TUN CVC W/O SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045010723","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3801.0,"discounted_cash":1330.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ CDM","code_information":[{"code":"Px00045010725","type":"CDM"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":6922.0,"discounted_cash":2422.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS EPICOND FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010726","type":"CDM"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL CDM","code_information":[{"code":"Px00045010727","type":"CDM"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":391.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM","code_information":[{"code":"Px00045010728","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS CONDYLAR FRACTURE CDM","code_information":[{"code":"Px00045010730","type":"CDM"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERT GASTROSTOMY TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010732","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":13547.0,"discounted_cash":4741.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010733","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.0,"discounted_cash":699.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS CONDYLAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010734","type":"CDM"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI CDM","code_information":[{"code":"Px00045010735","type":"CDM"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION CHALAZION SINGLE CDM","code_information":[{"code":"Px00045010737","type":"CDM"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.0,"discounted_cash":351.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010738","type":"CDM"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP CDM","code_information":[{"code":"Px00045010739","type":"CDM"},{"code":"96369","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":197.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010741","type":"CDM"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR CDM","code_information":[{"code":"Px00045010742","type":"CDM"},{"code":"96370","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION CDM","code_information":[{"code":"Px00045010744","type":"CDM"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANI CDM","code_information":[{"code":"Px00045010745","type":"CDM"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE CDM","code_information":[{"code":"Px00045010746","type":"CDM"},{"code":"24516","type":"HCPCS"}],"standard_charges":[{"gross_charge":20562.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION/CURETTAGE CYST/TUMOR METACARPAL CDM","code_information":[{"code":"Px00045010747","type":"CDM"},{"code":"26200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM","code_information":[{"code":"Px00045010749","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PRQ SKEL FIXJ FEMORAL FX PROX END NECK CDM","code_information":[{"code":"Px00045010750","type":"CDM"},{"code":"27235","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00045010752","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY CDM","code_information":[{"code":"Px00045010753","type":"CDM"},{"code":"27827","type":"HCPCS"}],"standard_charges":[{"gross_charge":20562.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA CDM","code_information":[{"code":"Px00045010755","type":"CDM"},{"code":"27828","type":"HCPCS"}],"standard_charges":[{"gross_charge":20562.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX RADIUS HD FRACTURE CDM","code_information":[{"code":"Px00045010756","type":"CDM"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION CDM","code_information":[{"code":"Px00045010757","type":"CDM"},{"code":"27829","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION VAGINAL CYST/TUMOR CDM","code_information":[{"code":"Px00045010759","type":"CDM"},{"code":"57135","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00045010760","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC CDM","code_information":[{"code":"Px00045010761","type":"CDM"},{"code":"96522","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST CDM","code_information":[{"code":"Px00045010763","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010764","type":"CDM"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FETAL NONSTRESS TEST CDM","code_information":[{"code":"Px00045010765","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH CDM","code_information":[{"code":"Px00045010767","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":4224.0,"discounted_cash":1478.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREARM FOREIGN BODY - WRIST/FOREARM CDM","code_information":[{"code":"Px00045010769","type":"CDM"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU CDM","code_information":[{"code":"Px00045010770","type":"CDM"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER CDM","code_information":[{"code":"Px00045010771","type":"CDM"},{"code":"31730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3589.0,"discounted_cash":1256.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION CDM","code_information":[{"code":"Px00045010773","type":"CDM"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FOREARM TENDON/MUSCLE SINGLE EA TENDON CDM","code_information":[{"code":"Px00045010774","type":"CDM"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE CDM","code_information":[{"code":"Px00045010775","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":474.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION INTRAUTERINE DEVICE IUD CDM","code_information":[{"code":"Px00045010777","type":"CDM"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":190.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS W/O MANIPULATION CDM","code_information":[{"code":"Px00045010778","type":"CDM"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE CDM","code_information":[{"code":"Px00045010779","type":"CDM"},{"code":"49460","type":"HCPCS"}],"standard_charges":[{"gross_charge":5236.0,"discounted_cash":1832.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPLACEMENT G-J TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010781","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":3136.0,"discounted_cash":1097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS W/MANIPULATION CDM","code_information":[{"code":"Px00045010782","type":"CDM"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM","code_information":[{"code":"Px00045010783","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00045010785","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":4425.0,"discounted_cash":1548.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT CDM","code_information":[{"code":"Px00045010786","type":"CDM"},{"code":"25520","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1169.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM","code_information":[{"code":"Px00045010787","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2383.0,"discounted_cash":834.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING CDM","code_information":[{"code":"Px00045010789","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":992.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00045010790","type":"CDM"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING CDM","code_information":[{"code":"Px00045010791","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":1041.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA CDM","code_information":[{"code":"Px00045010793","type":"CDM"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":5761.0,"discounted_cash":2016.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00045010794","type":"CDM"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REP TNDN ACHILLES W GRFT CDM","code_information":[{"code":"Px00045010795","type":"CDM"},{"code":"27652","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REP DISRUPT LIGAMENT ANKL SNGL CDM","code_information":[{"code":"Px00045010797","type":"CDM"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS AND ULNA W/O MANIP CDM","code_information":[{"code":"Px00045010798","type":"CDM"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED AMPUT METATARSAL W TOE SINGLE CDM","code_information":[{"code":"Px00045010799","type":"CDM"},{"code":"28810","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00045010801","type":"CDM"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM CDM","code_information":[{"code":"Px00045010802","type":"CDM"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM","code_information":[{"code":"Px00045010804","type":"CDM"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M LT/4.0CM CDM","code_information":[{"code":"Px00045010805","type":"CDM"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US CDM","code_information":[{"code":"Px00045010807","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2698.0,"discounted_cash":944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","code_information":[{"code":"Px00045010808","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ CERVICOTHORACIC INJECT CDM","code_information":[{"code":"Px00045010809","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":12881.0,"discounted_cash":4508.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PERQ LUMBOSACRAL INJECTION CDM","code_information":[{"code":"Px00045010811","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":12881.0,"discounted_cash":4508.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST BONE FRACTURE CDM","code_information":[{"code":"Px00045010812","type":"CDM"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN CDM","code_information":[{"code":"Px00045010813","type":"CDM"},{"code":"24545","type":"HCPCS"}],"standard_charges":[{"gross_charge":20562.0,"discounted_cash":7196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ LT/3CM CDM","code_information":[{"code":"Px00045010815","type":"CDM"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST BONE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010816","type":"CDM"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL CDM","code_information":[{"code":"Px00045010817","type":"CDM"},{"code":"26548","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES CDM","code_information":[{"code":"Px00045010819","type":"CDM"},{"code":"26675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPAL BONE FRACTURE W/O MANIP EACH BONE CDM","code_information":[{"code":"Px00045010820","type":"CDM"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ CDM","code_information":[{"code":"Px00045010821","type":"CDM"},{"code":"27268","type":"HCPCS"}],"standard_charges":[{"gross_charge":6794.0,"discounted_cash":2377.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES CDM","code_information":[{"code":"Px00045010823","type":"CDM"},{"code":"28545","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPAL BONE FRACTURE W/MANIP EACH BONE CDM","code_information":[{"code":"Px00045010824","type":"CDM"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION SHORT ARM SPLINT DYNAMIC CDM","code_information":[{"code":"Px00045010825","type":"CDM"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":258.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION FINGER SPLINT DYNAMIC CDM","code_information":[{"code":"Px00045010827","type":"CDM"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR STYLOID FRACTURE CDM","code_information":[{"code":"Px00045010828","type":"CDM"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF CHEST THORAX CDM","code_information":[{"code":"Px00045010829","type":"CDM"},{"code":"29200","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING SHOULDER CDM","code_information":[{"code":"Px00045010831","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST DISLOCATION W/MANIPULATION CDM","code_information":[{"code":"Px00045010832","type":"CDM"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":103.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF ELBOW OR WRIST CDM","code_information":[{"code":"Px00045010834","type":"CDM"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF HAND OR FINGER CDM","code_information":[{"code":"Px00045010835","type":"CDM"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISTAL RADIOULNAR DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010836","type":"CDM"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ADDITION OF WALKER TO CAST CDM","code_information":[{"code":"Px00045010837","type":"CDM"},{"code":"29440","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG CDM","code_information":[{"code":"Px00045010839","type":"CDM"},{"code":"29450","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT TRANS-SCAPHOPERIULNAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010840","type":"CDM"},{"code":"25680","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF CDM","code_information":[{"code":"Px00045010841","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2653.0,"discounted_cash":928.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LUNATE DISLOCATION W/MANIPULATION CDM","code_information":[{"code":"Px00045010843","type":"CDM"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY CDM","code_information":[{"code":"Px00045010844","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2669.0,"discounted_cash":934.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION PICC W/RS&I 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010846","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6956.0,"discounted_cash":2434.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PIN FINGER FRACTURE EACH CDM","code_information":[{"code":"Px00045010848","type":"CDM"},{"code":"26756","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL PHALANGEAL FRACTURE EACH CDM","code_information":[{"code":"Px00045010849","type":"CDM"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FINGER DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010851","type":"CDM"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FINGER DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010852","type":"CDM"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLLECT BLOOD FROM CATHETER VENOUS NOS CDM","code_information":[{"code":"Px00045010853","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED XTRNL CANNULA DECLTNG SPX W/O BALO CATH CDM","code_information":[{"code":"Px00045010854","type":"CDM"},{"code":"36860","type":"HCPCS"}],"standard_charges":[{"gross_charge":2466.0,"discounted_cash":863.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL CDM","code_information":[{"code":"Px00045010855","type":"CDM"},{"code":"38300","type":"HCPCS"}],"standard_charges":[{"gross_charge":9908.0,"discounted_cash":3467.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS PAROTID SIMPLE CDM","code_information":[{"code":"Px00045010856","type":"CDM"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS PAROTID COMPLICATED CDM","code_information":[{"code":"Px00045010858","type":"CDM"},{"code":"42305","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF FINGER ABCESS COMP CDM","code_information":[{"code":"Px00045010859","type":"CDM"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ CDM","code_information":[{"code":"Px00045010860","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":826.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER CDM","code_information":[{"code":"Px00045010861","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":4421.0,"discounted_cash":1547.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN CDM","code_information":[{"code":"Px00045010862","type":"CDM"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1569.0,"discounted_cash":549.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR CARDIAC WOUND W/O BYPASS CDM","code_information":[{"code":"Px00045010863","type":"CDM"},{"code":"33300","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.0,"discounted_cash":2417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM","code_information":[{"code":"Px00045010864","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP CDM","code_information":[{"code":"Px00045010865","type":"CDM"},{"code":"33320","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.0,"discounted_cash":2417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US CDM","code_information":[{"code":"Px00045010866","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT CDM","code_information":[{"code":"Px00045010867","type":"CDM"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION LONG LEG CAST BRACE CDM","code_information":[{"code":"Px00045010869","type":"CDM"},{"code":"29358","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE TENDON SHEATH LESION CDM","code_information":[{"code":"Px00045010870","type":"CDM"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND PROFUNDUS TENDON EA TENDON CDM","code_information":[{"code":"Px00045010871","type":"CDM"},{"code":"26370","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EXTENSOR TENDON HAND W/O GRAFT CDM","code_information":[{"code":"Px00045010872","type":"CDM"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REM SHOULDER HIP SPICA CDM","code_information":[{"code":"Px00045010875","type":"CDM"},{"code":"29710","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT CDM","code_information":[{"code":"Px00045010876","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM","code_information":[{"code":"Px00045010877","type":"CDM"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BX INTRANASAL MUCOSA CDM","code_information":[{"code":"Px00045010878","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMV FB NOSE BY LAT RHINOTOMY CDM","code_information":[{"code":"Px00045010879","type":"CDM"},{"code":"30320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH DX W WO CELL WASH CDM","code_information":[{"code":"Px00045010880","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH DX W ALVEOLAR LAV CDM","code_information":[{"code":"Px00045010881","type":"CDM"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH W FB REM CDM","code_information":[{"code":"Px00045010882","type":"CDM"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INS TUN PLEURAL CATH CDM","code_information":[{"code":"Px00045010884","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":13209.0,"discounted_cash":4623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLD VESSEL DIRECT NECK CDM","code_information":[{"code":"Px00045010885","type":"CDM"},{"code":"35201","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.0,"discounted_cash":2417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INS TUN CVC WO SQ PORT LT/5YRS CDM","code_information":[{"code":"Px00045010886","type":"CDM"},{"code":"36557","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING CDM","code_information":[{"code":"Px00045010887","type":"CDM"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/GT CDM","code_information":[{"code":"Px00045010888","type":"CDM"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INS PICCCTH WO PRT/PMP LT/5 W US CDM","code_information":[{"code":"Px00045010889","type":"CDM"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1674.0,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPLC NON TUN CVC WO PORT PUMP CDM","code_information":[{"code":"Px00045010890","type":"CDM"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":2374.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPLC TUN CV CATH WO PORT CDM","code_information":[{"code":"Px00045010891","type":"CDM"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":17674.0,"discounted_cash":6185.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPLC PICC WO PORT PUMP CDM","code_information":[{"code":"Px00045010892","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":5377.0,"discounted_cash":1881.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OR BX TEMPORAL ARTERY CDM","code_information":[{"code":"Px00045010893","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCSN MOUTH LSN W SMPL REP CDM","code_information":[{"code":"Px00045010894","type":"CDM"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED UGI W DILATION ESOPHAGUS BAL CDM","code_information":[{"code":"Px00045010895","type":"CDM"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":2913.0,"discounted_cash":1019.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED GASTRC INTUBN ASP DX SNGL SPEC CDM","code_information":[{"code":"Px00045010897","type":"CDM"},{"code":"43754","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":474.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRAFT CDM","code_information":[{"code":"Px00045010898","type":"CDM"},{"code":"26433","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR COLLATER LIGMNT METACAROPOPHALANGEAL OR INTERPHAL.JOINT CDM","code_information":[{"code":"Px00045010899","type":"CDM"},{"code":"26540","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00045010900","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PRESSURE TREATMENT ESOPHAGUS CDM","code_information":[{"code":"Px00045010902","type":"CDM"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3344.0,"discounted_cash":1170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE SINGLE W/MANIPULATION CDM","code_information":[{"code":"Px00045010904","type":"CDM"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRN ABSC PELV TRNSREC CDM","code_information":[{"code":"Px00045010906","type":"CDM"},{"code":"45000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2251.0,"discounted_cash":787.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SIGMOID DX FLX W WO SPEC COLL CDM","code_information":[{"code":"Px00045010907","type":"CDM"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1424.0,"discounted_cash":498.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010909","type":"CDM"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOPLASTY PROLAPSE MUC MBRM CDM","code_information":[{"code":"Px00045010911","type":"CDM"},{"code":"45505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REP PERINEAL APRCH CDM","code_information":[{"code":"Px00045010912","type":"CDM"},{"code":"45541","type":"HCPCS"}],"standard_charges":[{"gross_charge":4050.0,"discounted_cash":1417.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I&D SUPERF ABSC PERI/ISCHEAL CDM","code_information":[{"code":"Px00045010913","type":"CDM"},{"code":"46045","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1282.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ SCLEROSING SOL HEMORROIDS CDM","code_information":[{"code":"Px00045010914","type":"CDM"},{"code":"46500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":603.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TX CARPOMETACARPAL FRACTURE/DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010915","type":"CDM"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUC LSN ANUS SMPL CHEM CDM","code_information":[{"code":"Px00045010917","type":"CDM"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REM FB FROM PERITNL CAV CDM","code_information":[{"code":"Px00045010918","type":"CDM"},{"code":"49402","type":"HCPCS"}],"standard_charges":[{"gross_charge":5581.0,"discounted_cash":1953.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCHG ABSC CYST DRN CATH CDM","code_information":[{"code":"Px00045010919","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":17120.0,"discounted_cash":5992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO TX URETERAL STRICTURE CDM","code_information":[{"code":"Px00045010920","type":"CDM"},{"code":"52344","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":2065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX CARPO/METACARPL DISLO OTHER THAN THMB MANJ EA W/O ANES CDM","code_information":[{"code":"Px00045010921","type":"CDM"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO DX W URETSCP PYELSCP CDM","code_information":[{"code":"Px00045010923","type":"CDM"},{"code":"52351","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":2065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I&D PENIS LSN DEEP CDM","code_information":[{"code":"Px00045010924","type":"CDM"},{"code":"54015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010926","type":"CDM"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ORCHIOPEXY INGUINAL CDM","code_information":[{"code":"Px00045010927","type":"CDM"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":5581.0,"discounted_cash":1953.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY VULVA CDM","code_information":[{"code":"Px00045010928","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA CDM","code_information":[{"code":"Px00045010929","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION HYDRATION EACH ADDITIONAL HOUR CDM","code_information":[{"code":"Px00045010930","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":150.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010931","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":317.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM CDM","code_information":[{"code":"Px00045010932","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY WITH EXPLORATION CDM","code_information":[{"code":"Px00045010933","type":"CDM"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY W DRN PELV ABSCS CDM","code_information":[{"code":"Px00045010934","type":"CDM"},{"code":"57010","type":"HCPCS"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I&D HEMOTOMA VAG NON-OB CDM","code_information":[{"code":"Px00045010935","type":"CDM"},{"code":"57023","type":"HCPCS"}],"standard_charges":[{"gross_charge":5853.0,"discounted_cash":2048.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION CHEMICAL CERVIX CDM","code_information":[{"code":"Px00045010936","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-FETAL CONTRACT STRESS NS CDM","code_information":[{"code":"Px00045010938","type":"CDM"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-EXT CEPHAL VERS BREECH N CDM","code_information":[{"code":"Px00045010939","type":"CDM"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":6779.0,"discounted_cash":2372.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INDUCED ABORT DILATION CURETGE CDM","code_information":[{"code":"Px00045010940","type":"CDM"},{"code":"59840","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA CDM","code_information":[{"code":"Px00045010942","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER OR THUMB W/MANIP EA CDM","code_information":[{"code":"Px00045010943","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-REM CERCLAGE SUT ANES NS CDM","code_information":[{"code":"Px00045010944","type":"CDM"},{"code":"59871","type":"HCPCS"}],"standard_charges":[{"gross_charge":5693.0,"discounted_cash":1992.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ INTERLAMINR CRV-THOR W IMG CDM","code_information":[{"code":"Px00045010945","type":"CDM"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":3940.0,"discounted_cash":1379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM","code_information":[{"code":"Px00045010946","type":"CDM"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2817.0,"discounted_cash":985.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ EPI LUMB/SACRAL W IMAGING CDM","code_information":[{"code":"Px00045010947","type":"CDM"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":4022.0,"discounted_cash":1407.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ INF INTRLAM CRV THOR WO XR CDM","code_information":[{"code":"Px00045010948","type":"CDM"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00045010949","type":"CDM"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"discounted_cash":268.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ CDM","code_information":[{"code":"Px00045010950","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1358.0,"discounted_cash":475.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ANALYZE SP INFUS PMP W REPROG CDM","code_information":[{"code":"Px00045010951","type":"CDM"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ ANES NRV PUDENAL CDM","code_information":[{"code":"Px00045010952","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3083.0,"discounted_cash":1079.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD SCIATIC NRV CONT NFS CATH IMG CDM","code_information":[{"code":"Px00045010953","type":"CDM"},{"code":"64446","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX PHALANGEAL SHAFT FX FINGER/THUMB W/O MANIP CDM","code_information":[{"code":"Px00045010954","type":"CDM"},{"code":"26735","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NRV BLOCK INJ CELIAC PLEXUS CDM","code_information":[{"code":"Px00045010957","type":"CDM"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3083.0,"discounted_cash":1079.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJ EYE ANT CHAMBER W MEDS CDM","code_information":[{"code":"Px00045010958","type":"CDM"},{"code":"66030","type":"HCPCS"}],"standard_charges":[{"gross_charge":3561.0,"discounted_cash":1246.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RECON EYELID CDM","code_information":[{"code":"Px00045010959","type":"CDM"},{"code":"67950","type":"HCPCS"}],"standard_charges":[{"gross_charge":4941.0,"discounted_cash":1729.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLR TEAR DUCTS W WO IRRIG CDM","code_information":[{"code":"Px00045010960","type":"CDM"},{"code":"68840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.0,"discounted_cash":351.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED US GUID VASC ACCESS CDM","code_information":[{"code":"Px00045010962","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.0,"discounted_cash":494.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX ARTICULAR FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010963","type":"CDM"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED VENOUS PRESSURE DETERMINATION CDM","code_information":[{"code":"Px00045010964","type":"CDM"},{"code":"93770","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SUBQ IV INFUSION ADDL SITE CDM","code_information":[{"code":"Px00045010965","type":"CDM"},{"code":"96371","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ANOGENTL COLPO PED TRAUMA CDM","code_information":[{"code":"Px00045010966","type":"CDM"},{"code":"99170","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.0,"discounted_cash":312.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX ARTICULAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010974","type":"CDM"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX ARTICULARE FRACTURE CDM","code_information":[{"code":"Px00045010985","type":"CDM"},{"code":"26746","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX DISTAL PHALANGEAL FX FINGER/THUMB W/O MANIP EA -TUFT CDM","code_information":[{"code":"Px00045010986","type":"CDM"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX DISTAL PHALANG FX FINGER/THUMB W/MANIP TUFT FX CDM","code_information":[{"code":"Px00045010996","type":"CDM"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP CDM","code_information":[{"code":"Px00045011000","type":"CDM"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00045011001","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":231.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION THERAPY PROPHYLAXIS ADDL SEQUENTIAL TO 1 HR CDM","code_information":[{"code":"Px00045011002","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION TX/PROPHYLAXIS/DX EA ADDNL HOUR CDM","code_information":[{"code":"Px00045011003","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM","code_information":[{"code":"Px00045011004","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION TX/PROPHYLAXIS/DX CONCURRENT DRUG CDM","code_information":[{"code":"Px00045011005","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00045011006","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045011009","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":316.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EA SEQL SBST/DRUG FAC CDM","code_information":[{"code":"Px00045011010","type":"CDM"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM","code_information":[{"code":"Px00045011011","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":214.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EACH NEW DRUG CDM","code_information":[{"code":"Px00045011012","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM","code_information":[{"code":"Px00045011013","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL CDM","code_information":[{"code":"Px00045011014","type":"CDM"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":231.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED WOUND CLOSURE BY ADHESIVE CDM","code_information":[{"code":"Px00045011016","type":"CDM"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT CDM","code_information":[{"code":"Px00045011088","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":98.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PROX TIBFIB JT DISLC REQ ANES CDM","code_information":[{"code":"Px00045011089","type":"CDM"},{"code":"27831","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN CDM","code_information":[{"code":"Px00045011090","type":"CDM"},{"code":"99466","type":"HCPCS"}],"standard_charges":[{"gross_charge":1309.0,"discounted_cash":458.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN CDM","code_information":[{"code":"Px00045011091","type":"CDM"},{"code":"99467","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":230.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION PILONIDAL CYST/SINUS SIMPLE CDM","code_information":[{"code":"Px00045011092","type":"CDM"},{"code":"11770","type":"HCPCS"}],"standard_charges":[{"gross_charge":5853.0,"discounted_cash":2048.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM CDM","code_information":[{"code":"Px00045011093","type":"CDM"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":472.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC CDM","code_information":[{"code":"Px00045011094","type":"CDM"},{"code":"43755","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE CDM","code_information":[{"code":"Px00045011095","type":"CDM"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2437.0,"discounted_cash":852.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045011096","type":"CDM"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1674.0,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TEMPORARY CLOSURE EYELID BY SUTURE CDM","code_information":[{"code":"Px00045011111","type":"CDM"},{"code":"67875","type":"HCPCS"}],"standard_charges":[{"gross_charge":1244.0,"discounted_cash":435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE FX DIS FIBULA W/MANIP CDM","code_information":[{"code":"Px00045013002","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013005","type":"CDM"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE BIMALL W/MANIP CDM","code_information":[{"code":"Px00045013009","type":"CDM"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE TRIMAL W/O MANIP CDM","code_information":[{"code":"Px00045013011","type":"CDM"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM","code_information":[{"code":"Px00045013015","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT LOWER LEG FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013018","type":"CDM"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT LOWER LEG FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013020","type":"CDM"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013021","type":"CDM"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT ANKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045013025","type":"CDM"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREAT ANKLE DISLOCATION CDM","code_information":[{"code":"Px00045013027","type":"CDM"},{"code":"27846","type":"HCPCS"}],"standard_charges":[{"gross_charge":11380.0,"discounted_cash":3983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY CDM","code_information":[{"code":"Px00045013029","type":"CDM"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00045013032","type":"CDM"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00045013036","type":"CDM"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF FOOT TENDON CDM","code_information":[{"code":"Px00045013039","type":"CDM"},{"code":"28200","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF FOOT TENDON EXTENSOR TENDON CDM","code_information":[{"code":"Px00045013040","type":"CDM"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RELEASE OF BIG TOE CDM","code_information":[{"code":"Px00045013043","type":"CDM"},{"code":"28240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF HEEL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045013045","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF HEEL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013048","type":"CDM"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF TALUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013051","type":"CDM"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013054","type":"CDM"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT MIDFOOT FRACTURE EACH W/O MANIPULATION CDM","code_information":[{"code":"Px00045013056","type":"CDM"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT MIDFOOT FRACTURE EACH W/MANIPULATION CDM","code_information":[{"code":"Px00045013059","type":"CDM"},{"code":"28455","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045013063","type":"CDM"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT METATARSAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013065","type":"CDM"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT BIG TOE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013069","type":"CDM"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREAT BIG TOE FRACTURE CDM","code_information":[{"code":"Px00045013074","type":"CDM"},{"code":"28505","type":"HCPCS"}],"standard_charges":[{"gross_charge":6992.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ CDM","code_information":[{"code":"Px00045013075","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ CDM","code_information":[{"code":"Px00045013076","type":"CDM"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SESAMOID BONE FRACTURE CDM","code_information":[{"code":"Px00045013077","type":"CDM"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TARSAL DISLOCATION CDM","code_information":[{"code":"Px00045013078","type":"CDM"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00045013082","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045013083","type":"CDM"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":6145.0,"discounted_cash":2150.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013084","type":"CDM"},{"code":"28600","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METATARSOPHLNGL JT DISLC W/O ANES CDM","code_information":[{"code":"Px00045013087","type":"CDM"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METATARSOPHLNGL JT DISLC REQ ANES CDM","code_information":[{"code":"Px00045013090","type":"CDM"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3439.0,"discounted_cash":1203.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TOE DISLOCATION CDM","code_information":[{"code":"Px00045013091","type":"CDM"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT TOE DISLOCATION W/ANETH CDM","code_information":[{"code":"Px00045013092","type":"CDM"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF BODY CAST CDM","code_information":[{"code":"Px00045013094","type":"CDM"},{"code":"29035","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF SHOULDER CAST CDM","code_information":[{"code":"Px00045013095","type":"CDM"},{"code":"29055","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LONG ARM CAST APPLICATION CDM","code_information":[{"code":"Px00045013096","type":"CDM"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHORT ARM CAST APPLICATION CDM","code_information":[{"code":"Px00045013099","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLY HAND/WRIST CAST CDM","code_information":[{"code":"Px00045013103","type":"CDM"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLY FINGER CAST CDM","code_information":[{"code":"Px00045013105","type":"CDM"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LONG ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013106","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHORT ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013110","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF FINGER SPLINT STATIC CDM","code_information":[{"code":"Px00045013112","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HIP CAST CDM","code_information":[{"code":"Px00045013119","type":"CDM"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HIP CASTS CDM","code_information":[{"code":"Px00045013120","type":"CDM"},{"code":"29325","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF LONG LEG CAST CDM","code_information":[{"code":"Px00045013121","type":"CDM"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CYLINDER CAST APPLICATION CDM","code_information":[{"code":"Px00045013122","type":"CDM"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHORT LEG CAST APPLICATION CDM","code_information":[{"code":"Px00045013123","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLY SHORT WALKING LEG CAST CDM","code_information":[{"code":"Px00045013124","type":"CDM"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION LONG LEG SPLINT CDM","code_information":[{"code":"Px00045013127","type":"CDM"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SHORT LEG SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013130","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF KNEE CDM","code_information":[{"code":"Px00045013135","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF ANKLE AND/OR FT CDM","code_information":[{"code":"Px00045013137","type":"CDM"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF TOES CDM","code_information":[{"code":"Px00045013139","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOV BIVAL GAUN BOOT/BODY CAST CDM","code_information":[{"code":"Px00045013145","type":"CDM"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE OR BIVALVE CAST-FULL ARM OR LEG CDM","code_information":[{"code":"Px00045013147","type":"CDM"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF BODY CAST CDM","code_information":[{"code":"Px00045013150","type":"CDM"},{"code":"29720","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED WINDOWING OF CAST CDM","code_information":[{"code":"Px00045013151","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF PORC TIBIOFIBULAR JOINT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013166","type":"CDM"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM","code_information":[{"code":"Px00045013170","type":"CDM"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":423.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION COMPL CDM","code_information":[{"code":"Px00045013172","type":"CDM"},{"code":"40801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN OUTER EAR CANAL LESION CDM","code_information":[{"code":"Px00045013173","type":"CDM"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED POSTERIOR CDM","code_information":[{"code":"Px00045013183","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ CDM","code_information":[{"code":"Px00045013185","type":"CDM"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00045013187","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED NASAL/SINUS ENDOSCOPY SURG W/ HEMORRHAGE CONTROL CDM","code_information":[{"code":"Px00045013188","type":"CDM"},{"code":"31238","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED SINUS ENDO W/BALLOON DILATION CDM","code_information":[{"code":"Px00045013189","type":"CDM"},{"code":"31295","type":"HCPCS"}],"standard_charges":[{"gross_charge":11390.0,"discounted_cash":3986.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE OF WINDPIPE AIRWAY CDM","code_information":[{"code":"Px00045013191","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00045013192","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY LARYNX INDIRECT CDM","code_information":[{"code":"Px00045013193","type":"CDM"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00045013194","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY EXCL NEWBORN CDM","code_information":[{"code":"Px00045013195","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY W/FB REMOVAL CDM","code_information":[{"code":"Px00045013196","type":"CDM"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00045013197","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY WITH BIOPSY CDM","code_information":[{"code":"Px00045013198","type":"CDM"},{"code":"31576","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY LARYNX FLEXIBLE FIBEROPTIC CDM","code_information":[{"code":"Px00045013199","type":"CDM"},{"code":"31577","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF LARYNX LESION CDM","code_information":[{"code":"Px00045013200","type":"CDM"},{"code":"31578","type":"HCPCS"}],"standard_charges":[{"gross_charge":6138.0,"discounted_cash":2148.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY CDM","code_information":[{"code":"Px00045013201","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":3344.0,"discounted_cash":1170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00045013202","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3344.0,"discounted_cash":1170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED VISUALIZATION OF WINDPIPE CDM","code_information":[{"code":"Px00045013203","type":"CDM"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1422.0,"discounted_cash":497.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORATION/BIOPSY OF CHEST CDM","code_information":[{"code":"Px00045013206","type":"CDM"},{"code":"32100","type":"HCPCS"}],"standard_charges":[{"gross_charge":8629.0,"discounted_cash":3020.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPEN CHEST HEART MASSAGE CDM","code_information":[{"code":"Px00045013207","type":"CDM"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":8629.0,"discounted_cash":3020.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR AV FISTULA EXTREMITIES CDM","code_information":[{"code":"Px00045013209","type":"CDM"},{"code":"35190","type":"HCPCS"}],"standard_charges":[{"gross_charge":18714.0,"discounted_cash":6549.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION UPPER EXTREMITY CDM","code_information":[{"code":"Px00045013210","type":"CDM"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":7555.0,"discounted_cash":2644.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION HAND/FINGER CDM","code_information":[{"code":"Px00045013211","type":"CDM"},{"code":"35207","type":"HCPCS"}],"standard_charges":[{"gross_charge":7555.0,"discounted_cash":2644.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LIP FULL THICKNESS VERMILION ONLY CDM","code_information":[{"code":"Px00045013214","type":"CDM"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LIP FULL THICKNESS UP TO HALF VERTICAL HEIGHT CDM","code_information":[{"code":"Px00045013215","type":"CDM"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":398.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR LIP FULL THKNS GT/ONE-HALF VERT HEIGHT/COMPLE CDM","code_information":[{"code":"Px00045013216","type":"CDM"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1169.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION SIMPLE CDM","code_information":[{"code":"Px00045013217","type":"CDM"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY MOUTH SIMPLE CDM","code_information":[{"code":"Px00045013218","type":"CDM"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.0,"discounted_cash":699.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY MOUTH COMPLEX CDM","code_information":[{"code":"Px00045013219","type":"CDM"},{"code":"40805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MOUTH LACERATION LT/2.5CM CDM","code_information":[{"code":"Px00045013220","type":"CDM"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MOUTH LACERATION GT/2.5CM CDM","code_information":[{"code":"Px00045013221","type":"CDM"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION LINGUAL CDM","code_information":[{"code":"Px00045013222","type":"CDM"},{"code":"41000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":385.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INCISION & DRAINAGE OF MOUTH LESION SUBLINGUAL SUPERFICIAL CDM","code_information":[{"code":"Px00045013223","type":"CDM"},{"code":"41005","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR TONGUE LAC LT/2.6CM FLOOR OF MOUTH AND/OR ANTERIOR TWO-T CDM","code_information":[{"code":"Px00045013224","type":"CDM"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR TONGUE LACERATION LT/2.6CM POSTERIOR ONE-THIRD OF TONGUE CDM","code_information":[{"code":"Px00045013225","type":"CDM"},{"code":"41251","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED RPR LAC TONGUE FLOOR MOUTH GT/2.6 CM/CPLX CDM","code_information":[{"code":"Px00045013226","type":"CDM"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1446.0,"discounted_cash":506.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY GUM CDM","code_information":[{"code":"Px00045013227","type":"CDM"},{"code":"41805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.0,"discounted_cash":1027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE MOUTH ROOF LESION CDM","code_information":[{"code":"Px00045013229","type":"CDM"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT MOUTH ROOF LESION CDM","code_information":[{"code":"Px00045013230","type":"CDM"},{"code":"42160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LACERATION OF PALATE UP TO 2 CM CDM","code_information":[{"code":"Px00045013231","type":"CDM"},{"code":"42180","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF TONSIL ABSCESS CDM","code_information":[{"code":"Px00045013232","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF THROAT ABSCESS CDM","code_information":[{"code":"Px00045013233","type":"CDM"},{"code":"42720","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":1699.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE PHARYNX FOREIGN BODY CDM","code_information":[{"code":"Px00045013234","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING SIMPLE CDM","code_information":[{"code":"Px00045013235","type":"CDM"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEXIBLE BRUSH CDM","code_information":[{"code":"Px00045013237","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEX REMOVE FB CDM","code_information":[{"code":"Px00045013238","type":"CDM"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2913.0,"discounted_cash":1019.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED EGD US FINE NEEDLE BX/ASPIR CDM","code_information":[{"code":"Px00045013240","type":"CDM"},{"code":"43242","type":"HCPCS"}],"standard_charges":[{"gross_charge":2913.0,"discounted_cash":1019.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE CDM","code_information":[{"code":"Px00045013243","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":474.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED I/D FINGER ABSC-SIM-FA CDM","code_information":[{"code":"Px00045014005","type":"CDM"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX TOE FX W/O MANIP CDM","code_information":[{"code":"Px00045014022","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA CDM","code_information":[{"code":"Px00045014033","type":"CDM"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.0,"discounted_cash":312.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH CDM","code_information":[{"code":"Px00045014035","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1569.0,"discounted_cash":549.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00045014038","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":4401.0,"discounted_cash":1540.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH CDM","code_information":[{"code":"Px00045014040","type":"CDM"},{"code":"92975","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.0,"discounted_cash":2417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ABD PARACENTESIS W/O IMAG GUID CDM","code_information":[{"code":"Px00045014046","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2620.0,"discounted_cash":917.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM","code_information":[{"code":"Px00045014047","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":4435.0,"discounted_cash":1552.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FAC PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00045014048","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":2295.0,"discounted_cash":803.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045014050","type":"CDM"},{"code":"46601","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/ ANESTHESIA CDM","code_information":[{"code":"Px00045014051","type":"CDM"},{"code":"28605","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FUSION OF HAND BONES CDM","code_information":[{"code":"Px00045014052","type":"CDM"},{"code":"25820","type":"HCPCS"}],"standard_charges":[{"gross_charge":10294.0,"discounted_cash":3602.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED CLEAR OUTER EAR CANAL CDM","code_information":[{"code":"Px00045014053","type":"CDM"},{"code":"69205","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATE WRIST W/ANESTHES CDM","code_information":[{"code":"Px00045014054","type":"CDM"},{"code":"25259","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1058.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED OPN TX ORBIT FX W/O IMPLANT CDM","code_information":[{"code":"Px00045014055","type":"CDM"},{"code":"21406","type":"HCPCS"}],"standard_charges":[{"gross_charge":8418.0,"discounted_cash":2946.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EAR CANAL LESION(S) CDM","code_information":[{"code":"Px00045014056","type":"CDM"},{"code":"69145","type":"HCPCS"}],"standard_charges":[{"gross_charge":5145.0,"discounted_cash":1800.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST CDM","code_information":[{"code":"Px00045044404","type":"CDM"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":1467.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION CDM","code_information":[{"code":"Px00045050511","type":"CDM"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1026.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT CDM","code_information":[{"code":"Px00046010002","type":"CDM"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG","code_information":[{"code":"Px00046010011","type":"CDM"},{"code":"94617","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CO/MEMBANE DIFFUSE CAPACITY","code_information":[{"code":"Px00046010012","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT","code_information":[{"code":"Px00046010019","type":"CDM"},{"code":"94452","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":348.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION","code_information":[{"code":"Px00046010020","type":"CDM"},{"code":"94453","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOR OTH","code_information":[{"code":"Px00046010024","type":"CDM"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","code_information":[{"code":"Px00046010026","type":"CDM"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PULMONARY STRESS TESTING - SIX MINUTE WALK CDM","code_information":[{"code":"Px00046010048","type":"CDM"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RESPIRATORY FLOW VOLUME LOOP","code_information":[{"code":"Px00046010053","type":"CDM"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","code_information":[{"code":"Px00046010055","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SPIROMETRY PRE POST BRONCHODILATOR CDM","code_information":[{"code":"Px00046010063","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST CDM","code_information":[{"code":"Px00046010089","type":"CDM"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)","code_information":[{"code":"Px00046010090","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM","code_information":[{"code":"Px00046010092","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEARING SCREEN INPT CDM","code_information":[{"code":"Px00047010029","type":"CDM"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":187.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEARING SCREEN OUTPT CDM","code_information":[{"code":"Px00047010030","type":"CDM"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":187.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEARING SCREEN OUTPT-RESCREEN CDM","code_information":[{"code":"Px00047010032","type":"CDM"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":187.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R CDM","code_information":[{"code":"Px00047100005","type":"CDM"},{"code":"92652","type":"HCPCS"}],"standard_charges":[{"gross_charge":2434.0,"discounted_cash":851.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT CDM","code_information":[{"code":"Px00047100006","type":"CDM"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":271.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS CDM","code_information":[{"code":"Px00047110105","type":"CDM"},{"code":"92558","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ TRLUML CORONRY LITHOTRP ADD-ON CDM","code_information":[{"code":"Px00048000007","type":"CDM"},{"code":"92972","type":"HCPCS"}],"standard_charges":[{"gross_charge":12013.0,"discounted_cash":4204.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","code_information":[{"code":"Px00048010001","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":4292.0,"discounted_cash":1502.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX","code_information":[{"code":"Px00048010002","type":"CDM"},{"code":"92961","type":"HCPCS"}],"standard_charges":[{"gross_charge":5419.0,"discounted_cash":1896.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP","code_information":[{"code":"Px00048010057","type":"CDM"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":3417.0,"discounted_cash":1195.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD","code_information":[{"code":"Px00048010059","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1942.0,"discounted_cash":679.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R","code_information":[{"code":"Px00048010063","type":"CDM"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":3651.0,"discounted_cash":1277.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ","code_information":[{"code":"Px00048010064","type":"CDM"},{"code":"93318","type":"HCPCS"}],"standard_charges":[{"gross_charge":3651.0,"discounted_cash":1277.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD PW & CW","code_information":[{"code":"Px00048010066","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DOP ECHOCARD COLOR FLOW VELOCITY MAPPING CDM","code_information":[{"code":"Px00048010067","type":"CDM"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONT STRESS MONITOR","code_information":[{"code":"Px00048010069","type":"CDM"},{"code":"C8930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2939.0,"discounted_cash":1028.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","code_information":[{"code":"Px00048010074","type":"CDM"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST","code_information":[{"code":"Px00048010075","type":"CDM"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":4534.0,"discounted_cash":1586.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I","code_information":[{"code":"Px00048010076","type":"CDM"},{"code":"93662","type":"HCPCS"}],"standard_charges":[{"gross_charge":5344.0,"discounted_cash":1870.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TTE 2D W/WO CONTRAST DOP COLOR","code_information":[{"code":"Px00048010077","type":"CDM"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"gross_charge":5794.0,"discounted_cash":2027.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ","code_information":[{"code":"Px00048010078","type":"CDM"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":5426.0,"discounted_cash":1899.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PM DEVICE PROGR EVAL DUAL","code_information":[{"code":"Px00048010082","type":"CDM"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":38.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRGRMG EVAL MULT IMPLANTABLE DFB","code_information":[{"code":"Px00048010086","type":"CDM"},{"code":"93284","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM","code_information":[{"code":"Px00048010088","type":"CDM"},{"code":"93286","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRE-OP ICD DEVICE EVAL","code_information":[{"code":"Px00048010089","type":"CDM"},{"code":"93287","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRAVENTRICULAR PACING","code_information":[{"code":"Px00048010097","type":"CDM"},{"code":"93612","type":"HCPCS"}],"standard_charges":[{"gross_charge":16038.0,"discounted_cash":5613.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING","code_information":[{"code":"Px00048010109","type":"CDM"},{"code":"93613","type":"HCPCS"}],"standard_charges":[{"gross_charge":9155.0,"discounted_cash":3204.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INDUCTION ARRHYTHMIA ELECTRICAL PACING","code_information":[{"code":"Px00048010110","type":"CDM"},{"code":"93618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4939.0,"discounted_cash":1728.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION","code_information":[{"code":"Px00048010111","type":"CDM"},{"code":"93619","type":"HCPCS"}],"standard_charges":[{"gross_charge":12310.0,"discounted_cash":4308.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","code_information":[{"code":"Px00048010112","type":"CDM"},{"code":"93620","type":"HCPCS"}],"standard_charges":[{"gross_charge":12310.0,"discounted_cash":4308.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","code_information":[{"code":"Px00048010113","type":"CDM"},{"code":"93621","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC","code_information":[{"code":"Px00048010114","type":"CDM"},{"code":"93622","type":"HCPCS"}],"standard_charges":[{"gross_charge":1791.0,"discounted_cash":626.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS","code_information":[{"code":"Px00048010115","type":"CDM"},{"code":"93623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13993.0,"discounted_cash":4897.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE","code_information":[{"code":"Px00048010116","type":"CDM"},{"code":"93640","type":"HCPCS"}],"standard_charges":[{"gross_charge":3882.0,"discounted_cash":1358.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN","code_information":[{"code":"Px00048010117","type":"CDM"},{"code":"93641","type":"HCPCS"}],"standard_charges":[{"gross_charge":4573.0,"discounted_cash":1600.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","code_information":[{"code":"Px00048010118","type":"CDM"},{"code":"93642","type":"HCPCS"}],"standard_charges":[{"gross_charge":3302.0,"discounted_cash":1155.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION","code_information":[{"code":"Px00048010119","type":"CDM"},{"code":"93650","type":"HCPCS"}],"standard_charges":[{"gross_charge":30206.0,"discounted_cash":10572.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","code_information":[{"code":"Px00048010122","type":"CDM"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":5194.0,"discounted_cash":1817.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT","code_information":[{"code":"Px00048010134","type":"CDM"},{"code":"93624","type":"HCPCS"}],"standard_charges":[{"gross_charge":8213.0,"discounted_cash":2874.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION (CARDIAC ARREST)","code_information":[{"code":"Px00048010135","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":4401.0,"discounted_cash":1540.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TEE GUIDE (TAVR, PULMONARY OR MITRAL VALVE) W/CONTRAST","code_information":[{"code":"Px00048010159","type":"CDM"},{"code":"93355","type":"HCPCS"}],"standard_charges":[{"gross_charge":5220.0,"discounted_cash":1827.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","code_information":[{"code":"Px00048010160","type":"CDM"},{"code":"93644","type":"HCPCS"}],"standard_charges":[{"gross_charge":3302.0,"discounted_cash":1155.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC LITHOTRIP TIBI/PERONE CDM","code_information":[{"code":"Px00048100011","type":"CDM"},{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"gross_charge":44467.0,"discounted_cash":15563.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC LITHOTR-STENT TIB/PER CDM","code_information":[{"code":"Px00048100012","type":"CDM"},{"code":"C9773","type":"HCPCS"}],"standard_charges":[{"gross_charge":70627.0,"discounted_cash":24719.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF","code_information":[{"code":"Px00048100034","type":"CDM"},{"code":"36832","type":"HCPCS"}],"standard_charges":[{"gross_charge":18099.0,"discounted_cash":6334.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATHETER PLACEMENT&SBSQ REMOVAL CEPD PERQ CDM","code_information":[{"code":"Px00048100036","type":"CDM"},{"code":"33370","type":"HCPCS"}],"standard_charges":[{"gross_charge":18408.0,"discounted_cash":6442.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TCAT RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ","code_information":[{"code":"Px00048100039","type":"CDM"},{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"gross_charge":14748.0,"discounted_cash":5161.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY BI CDM","code_information":[{"code":"Px00048100047","type":"CDM"},{"code":"93573","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEART INSTANT FLOW RESERVE MEASURE CDM","code_information":[{"code":"Px00048100062","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":535.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC LITH-STEN-ATH TIB/PER","code_information":[{"code":"Px00048100064","type":"CDM"},{"code":"C9775","type":"HCPCS"}],"standard_charges":[{"gross_charge":57040.0,"discounted_cash":19964.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","code_information":[{"code":"Px00048100069","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRQ TCAT THER RX NTRAC BALO1 CDM","code_information":[{"code":"Px00048100098","type":"CDM"},{"code":"0913T","type":"HCPCS"}],"standard_charges":[{"gross_charge":16830.0,"discounted_cash":5890.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRQ TCAT THR RX NTRC BAL SEP CDM","code_information":[{"code":"Px00048100099","type":"CDM"},{"code":"0914T","type":"HCPCS"}],"standard_charges":[{"gross_charge":10742.0,"discounted_cash":3759.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ PERM CCM-D SYS PG&ELTRD CDM","code_information":[{"code":"Px00048100100","type":"CDM"},{"code":"0915T","type":"HCPCS"}],"standard_charges":[{"gross_charge":66256.0,"discounted_cash":23189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ PERM CCM-D SYS PG ONLY CDM","code_information":[{"code":"Px00048100101","type":"CDM"},{"code":"0916T","type":"HCPCS"}],"standard_charges":[{"gross_charge":66256.0,"discounted_cash":23189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ PERM CCM-D SYS 1 LEAD CDM","code_information":[{"code":"Px00048100102","type":"CDM"},{"code":"0917T","type":"HCPCS"}],"standard_charges":[{"gross_charge":24427.0,"discounted_cash":8549.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ PERM CCM-D SYS DUAL LD CDM","code_information":[{"code":"Px00048100103","type":"CDM"},{"code":"0918T","type":"HCPCS"}],"standard_charges":[{"gross_charge":24427.0,"discounted_cash":8549.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL PERM CCM-D SYS PG ONLY CDM","code_information":[{"code":"Px00048100104","type":"CDM"},{"code":"0919T","type":"HCPCS"}],"standard_charges":[{"gross_charge":10742.0,"discounted_cash":3759.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL PERM CCM-D SYS 1 PAC LD CDM","code_information":[{"code":"Px00048100105","type":"CDM"},{"code":"0920T","type":"HCPCS"}],"standard_charges":[{"gross_charge":10742.0,"discounted_cash":3759.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ELEC ALYS NSTIM SYS VGS SMPL CDM","code_information":[{"code":"Px00048100106","type":"CDM"},{"code":"0921T","type":"HCPCS"}],"standard_charges":[{"gross_charge":10742.0,"discounted_cash":3759.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL PERM CCM-D SYS DUAL LD CDM","code_information":[{"code":"Px00048100107","type":"CDM"},{"code":"0922T","type":"HCPCS"}],"standard_charges":[{"gross_charge":10742.0,"discounted_cash":3759.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RMVL&RPLCMT PERM CCM-D PG CDM","code_information":[{"code":"Px00048100108","type":"CDM"},{"code":"0923T","type":"HCPCS"}],"standard_charges":[{"gross_charge":66256.0,"discounted_cash":23189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RPOS PRV CCM-D TRNSVNS ELTRD CDM","code_information":[{"code":"Px00048100109","type":"CDM"},{"code":"0924T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1826.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RLCJ SKIN POCKET CCM-D PG CDM","code_information":[{"code":"Px00048100110","type":"CDM"},{"code":"0925T","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":38.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRGRMG DEV EVAL CCM-D IP CDM","code_information":[{"code":"Px00048100111","type":"CDM"},{"code":"0926T","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTERROG DEV EVAL CCM-D IP CDM","code_information":[{"code":"Px00048100112","type":"CDM"},{"code":"0927T","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REM INTERROG DEV CCM-D PHYS CDM","code_information":[{"code":"Px00048100113","type":"CDM"},{"code":"0928T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3484.0,"discounted_cash":1219.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EPHYS EVAL CCM-D LD 1ST IMPL CDM","code_information":[{"code":"Px00048100114","type":"CDM"},{"code":"0930T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3583.0,"discounted_cash":1254.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ TCAT PLMT NTRAC ST 2+LES 2+ST 2+C SEGMENTS CDM","code_information":[{"code":"Px00048100131","type":"CDM"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":8427.0,"discounted_cash":2949.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC DELIVERY AORTIC WALL STABLJ DRUG THER PERQ CDM","code_information":[{"code":"Px00048100132","type":"CDM"},{"code":"0994T","type":"HCPCS"}],"standard_charges":[{"gross_charge":61909.0,"discounted_cash":21668.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC DELIVERY AORTIC WALL STABLJ DRUG THER OPEN CDM","code_information":[{"code":"Px00048100133","type":"CDM"},{"code":"0995T","type":"HCPCS"}],"standard_charges":[{"gross_charge":77386.0,"discounted_cash":27085.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-AO NDGFT","code_information":[{"code":"Px00048110004","type":"CDM"},{"code":"34701","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-AO NDGFT RPT","code_information":[{"code":"Px00048110005","type":"CDM"},{"code":"34702","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-UNILAC NDGFT","code_information":[{"code":"Px00048110006","type":"CDM"},{"code":"34703","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-UNILAC NDGFT RPT","code_information":[{"code":"Px00048110007","type":"CDM"},{"code":"34704","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVAC RPR A-BIILIAC NDGFT","code_information":[{"code":"Px00048110008","type":"CDM"},{"code":"34705","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-BIILIAC RPT","code_information":[{"code":"Px00048110010","type":"CDM"},{"code":"34706","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC SINGLE","code_information":[{"code":"Px00048110011","type":"CDM"},{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"gross_charge":63486.0,"discounted_cash":22220.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC EA ADDL BRANCH","code_information":[{"code":"Px00048110012","type":"CDM"},{"code":"C9601","type":"HCPCS"}],"standard_charges":[{"gross_charge":8642.0,"discounted_cash":3024.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC ATHER SINGLE","code_information":[{"code":"Px00048110013","type":"CDM"},{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"gross_charge":61909.0,"discounted_cash":21668.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC ATHER ADDL BRANCH","code_information":[{"code":"Px00048110014","type":"CDM"},{"code":"C9603","type":"HCPCS"}],"standard_charges":[{"gross_charge":8427.0,"discounted_cash":2949.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CABG SINGLE","code_information":[{"code":"Px00048110015","type":"CDM"},{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"gross_charge":65004.0,"discounted_cash":22751.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CABG ADDL BRANCH","code_information":[{"code":"Px00048110016","type":"CDM"},{"code":"C9605","type":"HCPCS"}],"standard_charges":[{"gross_charge":8844.0,"discounted_cash":3095.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC W AMI SINGLE","code_information":[{"code":"Px00048110017","type":"CDM"},{"code":"C9606","type":"HCPCS"}],"standard_charges":[{"gross_charge":68100.0,"discounted_cash":23835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CHRONIC SINGLE","code_information":[{"code":"Px00048110018","type":"CDM"},{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"gross_charge":68722.0,"discounted_cash":24052.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC REVASC CHRONIC ADDL BRANCH","code_information":[{"code":"Px00048110019","type":"CDM"},{"code":"C9608","type":"HCPCS"}],"standard_charges":[{"gross_charge":8844.0,"discounted_cash":3095.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPRE EP EVAL ABLTJ 3D MAPG TX SVT","code_information":[{"code":"Px00048110020","type":"CDM"},{"code":"93653","type":"HCPCS"}],"standard_charges":[{"gross_charge":62880.0,"discounted_cash":22008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPRE EP EVAL ABLTJ 3D MAPG TX VT","code_information":[{"code":"Px00048110021","type":"CDM"},{"code":"93654","type":"HCPCS"}],"standard_charges":[{"gross_charge":73852.0,"discounted_cash":25848.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON","code_information":[{"code":"Px00048110022","type":"CDM"},{"code":"93655","type":"HCPCS"}],"standard_charges":[{"gross_charge":20957.0,"discounted_cash":7334.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION","code_information":[{"code":"Px00048110023","type":"CDM"},{"code":"93656","type":"HCPCS"}],"standard_charges":[{"gross_charge":73852.0,"discounted_cash":25848.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN","code_information":[{"code":"Px00048110024","type":"CDM"},{"code":"93657","type":"HCPCS"}],"standard_charges":[{"gross_charge":20957.0,"discounted_cash":7334.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH","code_information":[{"code":"Px00048110025","type":"CDM"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":31756.0,"discounted_cash":11114.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH","code_information":[{"code":"Px00048110026","type":"CDM"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":8427.0,"discounted_cash":2949.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","code_information":[{"code":"Px00048110027","type":"CDM"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":30967.0,"discounted_cash":10838.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH","code_information":[{"code":"Px00048110028","type":"CDM"},{"code":"92925","type":"HCPCS"}],"standard_charges":[{"gross_charge":8427.0,"discounted_cash":2949.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH","code_information":[{"code":"Px00048110029","type":"CDM"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":61909.0,"discounted_cash":21668.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML W/ANGIO ADDL ART/BRNCH","code_information":[{"code":"Px00048110030","type":"CDM"},{"code":"92929","type":"HCPCS"}],"standard_charges":[{"gross_charge":8427.0,"discounted_cash":2949.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML ATH/ANGIO ONE ART/BRNCH","code_information":[{"code":"Px00048110031","type":"CDM"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":61909.0,"discounted_cash":21668.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML ATH/ANGIO ADDL BRANCH","code_information":[{"code":"Px00048110032","type":"CDM"},{"code":"92934","type":"HCPCS"}],"standard_charges":[{"gross_charge":8427.0,"discounted_cash":2949.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT BYPASS GRAFT TRLUML REVASC ONE VESSEL","code_information":[{"code":"Px00048110033","type":"CDM"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":65004.0,"discounted_cash":22751.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT BYPASS GRAFT TRLUML REVASC ADDL VESSEL","code_information":[{"code":"Px00048110034","type":"CDM"},{"code":"92938","type":"HCPCS"}],"standard_charges":[{"gross_charge":8844.0,"discounted_cash":3095.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT TRLUML TOT OCCLUS REVASC MI ONE VSL","code_information":[{"code":"Px00048110035","type":"CDM"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":68100.0,"discounted_cash":23835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT TRLUML CHRONIC OCCLUS REVASC ONE VSL","code_information":[{"code":"Px00048110036","type":"CDM"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":67014.0,"discounted_cash":23454.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT TRLUML CHRONIC OCCLUS REVASC ADDL VSL","code_information":[{"code":"Px00048110037","type":"CDM"},{"code":"92944","type":"HCPCS"}],"standard_charges":[{"gross_charge":8844.0,"discounted_cash":3095.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR ILIO-ILIAC NDGFT","code_information":[{"code":"Px00048110042","type":"CDM"},{"code":"34707","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR ILIO-ILIAC RPT","code_information":[{"code":"Px00048110043","type":"CDM"},{"code":"34708","type":"HCPCS"}],"standard_charges":[{"gross_charge":26064.0,"discounted_cash":9122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PLMT XTN PROSTH EVASC RPR","code_information":[{"code":"Px00048110044","type":"CDM"},{"code":"34709","type":"HCPCS"}],"standard_charges":[{"gross_charge":11919.0,"discounted_cash":4171.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DLYD PLMT XTN PROSTH 1ST VSL","code_information":[{"code":"Px00048110045","type":"CDM"},{"code":"34710","type":"HCPCS"}],"standard_charges":[{"gross_charge":17893.0,"discounted_cash":6262.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DLYD PLMT XTN PROSTH EA ADDL","code_information":[{"code":"Px00048110046","type":"CDM"},{"code":"34711","type":"HCPCS"}],"standard_charges":[{"gross_charge":8947.0,"discounted_cash":3131.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ ACCESS & CLSR FEM ART","code_information":[{"code":"Px00048110048","type":"CDM"},{"code":"34713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11248.0,"discounted_cash":3936.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC OPN AX/SUBCLA ART EXPOS","code_information":[{"code":"Px00048110050","type":"CDM"},{"code":"34715","type":"HCPCS"}],"standard_charges":[{"gross_charge":5681.0,"discounted_cash":1988.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","code_information":[{"code":"Px00048110054","type":"CDM"},{"code":"36482","type":"HCPCS"}],"standard_charges":[{"gross_charge":43410.0,"discounted_cash":15193.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN","code_information":[{"code":"Px00048110055","type":"CDM"},{"code":"36483","type":"HCPCS"}],"standard_charges":[{"gross_charge":21709.0,"discounted_cash":7598.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC INTRAVASC LITHOTRIPSY","code_information":[{"code":"Px00048110073","type":"CDM"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":26335.0,"discounted_cash":9217.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC INTRA LITHOTRIP-STENT","code_information":[{"code":"Px00048110074","type":"CDM"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":70627.0,"discounted_cash":24719.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC INTRA LITHOTRIP-ATHER","code_information":[{"code":"Px00048110075","type":"CDM"},{"code":"C9766","type":"HCPCS"}],"standard_charges":[{"gross_charge":63438.0,"discounted_cash":22203.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVASC LITHOTRIP-STENT-ATHER","code_information":[{"code":"Px00048110076","type":"CDM"},{"code":"C9767","type":"HCPCS"}],"standard_charges":[{"gross_charge":63438.0,"discounted_cash":22203.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY","code_information":[{"code":"Px00048110101","type":"CDM"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":18241.0,"discounted_cash":6384.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH","code_information":[{"code":"Px00048110103","type":"CDM"},{"code":"92975","type":"HCPCS"}],"standard_charges":[{"gross_charge":6907.0,"discounted_cash":2417.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","code_information":[{"code":"Px00048110106","type":"CDM"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"discounted_cash":643.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL","code_information":[{"code":"Px00048110107","type":"CDM"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVISION OF AORTIC VALVE","code_information":[{"code":"Px00048110115","type":"CDM"},{"code":"92986","type":"HCPCS"}],"standard_charges":[{"gross_charge":12628.0,"discounted_cash":4419.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REVISION OF MITRAL VALVE","code_information":[{"code":"Px00048110116","type":"CDM"},{"code":"92987","type":"HCPCS"}],"standard_charges":[{"gross_charge":12628.0,"discounted_cash":4419.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","code_information":[{"code":"Px00048110141","type":"CDM"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":23941.0,"discounted_cash":8379.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEFT HRT CATH W/VENTRCLGRPHY","code_information":[{"code":"Px00048110142","type":"CDM"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":23347.0,"discounted_cash":8171.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R & L HRT CATH W/NJX L VENTRICULOG IMG S&I","code_information":[{"code":"Px00048110143","type":"CDM"},{"code":"93453","type":"HCPCS"}],"standard_charges":[{"gross_charge":35841.0,"discounted_cash":12544.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I","code_information":[{"code":"Px00048110144","type":"CDM"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":27665.0,"discounted_cash":9682.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I","code_information":[{"code":"Px00048110145","type":"CDM"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":37384.0,"discounted_cash":13084.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I","code_information":[{"code":"Px00048110146","type":"CDM"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":35841.0,"discounted_cash":12544.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","code_information":[{"code":"Px00048110147","type":"CDM"},{"code":"93457","type":"HCPCS"}],"standard_charges":[{"gross_charge":34951.0,"discounted_cash":12232.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I","code_information":[{"code":"Px00048110148","type":"CDM"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":35841.0,"discounted_cash":12544.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I","code_information":[{"code":"Px00048110149","type":"CDM"},{"code":"93459","type":"HCPCS"}],"standard_charges":[{"gross_charge":46514.0,"discounted_cash":16279.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R & L HRT CATH WINJX HRT ART& L VENTR IMG","code_information":[{"code":"Px00048110150","type":"CDM"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":40052.0,"discounted_cash":14018.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I","code_information":[{"code":"Px00048110151","type":"CDM"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":47451.0,"discounted_cash":16607.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE CDM","code_information":[{"code":"Px00048110152","type":"CDM"},{"code":"93462","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.0,"discounted_cash":1851.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MEDICATION ADMIN & HEMODYNAMIC MEASURMENT","code_information":[{"code":"Px00048110153","type":"CDM"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING","code_information":[{"code":"Px00048110156","type":"CDM"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.0,"discounted_cash":1851.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF HEART LINING","code_information":[{"code":"Px00048110158","type":"CDM"},{"code":"93505","type":"HCPCS"}],"standard_charges":[{"gross_charge":5291.0,"discounted_cash":1851.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I","code_information":[{"code":"Px00048110186","type":"CDM"},{"code":"93566","type":"HCPCS"}],"standard_charges":[{"gross_charge":4083.0,"discounted_cash":1429.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I","code_information":[{"code":"Px00048110187","type":"CDM"},{"code":"93567","type":"HCPCS"}],"standard_charges":[{"gross_charge":4993.0,"discounted_cash":1747.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ NSLCTV P-ART ANGIOGRAPHY CDM","code_information":[{"code":"Px00048110188","type":"CDM"},{"code":"93568","type":"HCPCS"}],"standard_charges":[{"gross_charge":3157.0,"discounted_cash":1104.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL","code_information":[{"code":"Px00048110189","type":"CDM"},{"code":"93571","type":"HCPCS"}],"standard_charges":[{"gross_charge":1861.0,"discounted_cash":651.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL","code_information":[{"code":"Px00048110190","type":"CDM"},{"code":"93572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":397.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH CLOSURE OF ASD","code_information":[{"code":"Px00048110191","type":"CDM"},{"code":"93580","type":"HCPCS"}],"standard_charges":[{"gross_charge":88825.0,"discounted_cash":31088.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BUNDLE OF HIS RECORDING","code_information":[{"code":"Px00048110193","type":"CDM"},{"code":"93600","type":"HCPCS"}],"standard_charges":[{"gross_charge":9759.0,"discounted_cash":3415.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRA-ATRIAL RECORDING","code_information":[{"code":"Px00048110194","type":"CDM"},{"code":"93602","type":"HCPCS"}],"standard_charges":[{"gross_charge":16038.0,"discounted_cash":5613.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RIGHT VENTRICULAR RECORDING","code_information":[{"code":"Px00048110195","type":"CDM"},{"code":"93603","type":"HCPCS"}],"standard_charges":[{"gross_charge":4130.0,"discounted_cash":1445.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA","code_information":[{"code":"Px00048110196","type":"CDM"},{"code":"93609","type":"HCPCS"}],"standard_charges":[{"gross_charge":3828.0,"discounted_cash":1339.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INTRA-ATRIAL PACING","code_information":[{"code":"Px00048110197","type":"CDM"},{"code":"93610","type":"HCPCS"}],"standard_charges":[{"gross_charge":9474.0,"discounted_cash":3315.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIOVASCULAR PROCEDURE","code_information":[{"code":"Px00048110210","type":"CDM"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":11091.0,"discounted_cash":3881.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ILIAC ART ANGIO,CARDIAC CATH","code_information":[{"code":"Px00048110224","type":"CDM"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL","code_information":[{"code":"Px00048110343","type":"CDM"},{"code":"35372","type":"HCPCS"}],"standard_charges":[{"gross_charge":24717.0,"discounted_cash":8650.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS INITIATION VENO-VENOUS","code_information":[{"code":"Px00048110410","type":"CDM"},{"code":"33946","type":"HCPCS"}],"standard_charges":[{"gross_charge":7840.0,"discounted_cash":2744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS INITIATION VENO-ARTERIAL","code_information":[{"code":"Px00048110411","type":"CDM"},{"code":"33947","type":"HCPCS"}],"standard_charges":[{"gross_charge":7840.0,"discounted_cash":2744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS","code_information":[{"code":"Px00048110412","type":"CDM"},{"code":"33948","type":"HCPCS"}],"standard_charges":[{"gross_charge":9720.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL","code_information":[{"code":"Px00048110413","type":"CDM"},{"code":"33949","type":"HCPCS"}],"standard_charges":[{"gross_charge":7840.0,"discounted_cash":2744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ","code_information":[{"code":"Px00048110415","type":"CDM"},{"code":"33952","type":"HCPCS"}],"standard_charges":[{"gross_charge":18858.0,"discounted_cash":6600.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER","code_information":[{"code":"Px00048110427","type":"CDM"},{"code":"33966","type":"HCPCS"}],"standard_charges":[{"gross_charge":7493.0,"discounted_cash":2622.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK MITRAL","code_information":[{"code":"Px00048110435","type":"CDM"},{"code":"93590","type":"HCPCS"}],"standard_charges":[{"gross_charge":52267.0,"discounted_cash":18293.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK AORTIC","code_information":[{"code":"Px00048110436","type":"CDM"},{"code":"93591","type":"HCPCS"}],"standard_charges":[{"gross_charge":52267.0,"discounted_cash":18293.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK EA ADDL","code_information":[{"code":"Px00048110437","type":"CDM"},{"code":"93592","type":"HCPCS"}],"standard_charges":[{"gross_charge":13067.0,"discounted_cash":4573.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT","code_information":[{"code":"Px00048110441","type":"CDM"},{"code":"33340","type":"HCPCS"}],"standard_charges":[{"gross_charge":26618.0,"discounted_cash":9316.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TCAT INS 2CHMBR LDLS PM CMPL","code_information":[{"code":"Px00048110444","type":"CDM"},{"code":"0795T","type":"HCPCS"}],"standard_charges":[{"gross_charge":66031.0,"discounted_cash":23110.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY","code_information":[{"code":"Px00048210003","type":"CDM"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1749.0,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC REMOTE 30 DAY ECG TECH SUPP","code_information":[{"code":"Px00048210016","type":"CDM"},{"code":"93229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EVENT MONITOR ATTENDED 30 DAY, CONNECTION/RECORDING& DISCONNECTION","code_information":[{"code":"Px00048210019","type":"CDM"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":44.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL CDM","code_information":[{"code":"Px00048300001","type":"CDM"},{"code":"93319","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY","code_information":[{"code":"Px00048310001","type":"CDM"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":4209.0,"discounted_cash":1473.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY","code_information":[{"code":"Px00048310002","type":"CDM"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":1894.0,"discounted_cash":662.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TTE 2D W DOPPLER COMPLETE","code_information":[{"code":"Px00048310003","type":"CDM"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":5650.0,"discounted_cash":1977.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH CDM","code_information":[{"code":"Px00048310004","type":"CDM"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":360.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD","code_information":[{"code":"Px00048310013","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO STRESS W/INTERP REPT & MONITOR","code_information":[{"code":"Px00048310016","type":"CDM"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":1879.0,"discounted_cash":657.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST F/U LIMITED","code_information":[{"code":"Px00048310020","type":"CDM"},{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1894.0,"discounted_cash":662.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO TEE W/WO CONTRAST COMPLETE","code_information":[{"code":"Px00048310021","type":"CDM"},{"code":"C8925","type":"HCPCS"}],"standard_charges":[{"gross_charge":3786.0,"discounted_cash":1325.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST STRESS TEST","code_information":[{"code":"Px00048310024","type":"CDM"},{"code":"C8928","type":"HCPCS"}],"standard_charges":[{"gross_charge":4534.0,"discounted_cash":1586.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MUSCLE TEST NONPARASPINAL","code_information":[{"code":"Px00051010001","type":"CDM"},{"code":"95870","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":89.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF UTERUS LINING","code_information":[{"code":"Px00051010130","type":"CDM"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD SUPRASCAPULAR NERVE CDM","code_information":[{"code":"Px00051010133","type":"CDM"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ/LESS THAN 3CM","code_information":[{"code":"Px00051010360","type":"CDM"},{"code":"24075","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.0,"discounted_cash":1216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL CDM","code_information":[{"code":"Px00051010375","type":"CDM"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":391.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION CDM","code_information":[{"code":"Px00051010401","type":"CDM"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"discounted_cash":268.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1  CDM","code_information":[{"code":"Px00051010403","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHAVING SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM  CDM","code_information":[{"code":"Px00051010408","type":"CDM"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/OR LESS CDM","code_information":[{"code":"Px00051010410","type":"CDM"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM","code_information":[{"code":"Px00051010417","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM CDM","code_information":[{"code":"Px00051010418","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM CDM","code_information":[{"code":"Px00051010419","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.0,"discounted_cash":537.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRIMMING NONDYSTROPHIC NAILS ANY NUMBER","code_information":[{"code":"Px00051010440","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":156.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ABBR BREAST SCREEN BILATERAL W WO CONTRAST LIMITED","code_information":[{"code":"Px00061000003","type":"CDM"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI IMAGE JAW JOINT TMJ","code_information":[{"code":"Px00061010002","type":"CDM"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":9716.0,"discounted_cash":3400.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK W CONTRAST","code_information":[{"code":"Px00061010005","type":"CDM"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":5948.0,"discounted_cash":2081.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK WO & W CONTRAST","code_information":[{"code":"Px00061010007","type":"CDM"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":6248.0,"discounted_cash":2186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO CONTRAST","code_information":[{"code":"Px00061010009","type":"CDM"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":7358.0,"discounted_cash":2575.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD W CONTRAST","code_information":[{"code":"Px00061010010","type":"CDM"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":7552.0,"discounted_cash":2643.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO & W CONTRAST","code_information":[{"code":"Px00061010012","type":"CDM"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":7943.0,"discounted_cash":2780.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO CONTRAST","code_information":[{"code":"Px00061010013","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":7358.0,"discounted_cash":2575.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA NECK W CONTRAST","code_information":[{"code":"Px00061010014","type":"CDM"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":7552.0,"discounted_cash":2643.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO & W CONTRAST","code_information":[{"code":"Px00061010015","type":"CDM"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":7943.0,"discounted_cash":2780.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010019","type":"CDM"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":1874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010022","type":"CDM"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":5889.0,"discounted_cash":2061.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO & W CONTRAST","code_information":[{"code":"Px00061010025","type":"CDM"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6186.0,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO CONTRAST","code_information":[{"code":"Px00061010029","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":6054.0,"discounted_cash":2118.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS W CONTRAST","code_information":[{"code":"Px00061010038","type":"CDM"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":6652.0,"discounted_cash":2328.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061010044","type":"CDM"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":6989.0,"discounted_cash":2446.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010053","type":"CDM"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":6186.0,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010054","type":"CDM"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":1874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT W CONTRAST","code_information":[{"code":"Px00061010057","type":"CDM"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":5889.0,"discounted_cash":2061.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010059","type":"CDM"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6186.0,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010063","type":"CDM"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":1874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010065","type":"CDM"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":1874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010066","type":"CDM"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5889.0,"discounted_cash":2061.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010068","type":"CDM"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":6186.0,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010075","type":"CDM"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":1874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010077","type":"CDM"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5889.0,"discounted_cash":2061.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010079","type":"CDM"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":6478.0,"discounted_cash":2267.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI MRCP ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010082","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":1874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010083","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":1874.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN W CONTRAST","code_information":[{"code":"Px00061010085","type":"CDM"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":5889.0,"discounted_cash":2061.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO & W CONTRAST","code_information":[{"code":"Px00061010087","type":"CDM"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":6186.0,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH","code_information":[{"code":"Px00061010090","type":"CDM"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1259.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH W/WO DYE","code_information":[{"code":"Px00061010092","type":"CDM"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":1449.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC VELOC FLOW MAPPING","code_information":[{"code":"Px00061010094","type":"CDM"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI SPECTROSCOPY","code_information":[{"code":"Px00061010095","type":"CDM"},{"code":"76390","type":"HCPCS"}],"standard_charges":[{"gross_charge":3930.0,"discounted_cash":1375.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010114","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1259.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010115","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1259.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010116","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1259.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA W/CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010123","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1259.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA W/O CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010124","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1259.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA W/O AND W/CONT UPPER EXTREMITY","code_information":[{"code":"Px00061010125","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1259.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY W/DYE","code_information":[{"code":"Px00061010137","type":"CDM"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":5889.0,"discounted_cash":2061.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK W/O DYE","code_information":[{"code":"Px00061010142","type":"CDM"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":5411.0,"discounted_cash":1893.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010143","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":1449.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010144","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":1449.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010145","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":1449.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MR ANGIO PELVIS W/O DYE","code_information":[{"code":"Px00061010148","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3514.0,"discounted_cash":1229.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W & W/O DYE","code_information":[{"code":"Px00061010237","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":1449.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W/DYE","code_information":[{"code":"Px00061010238","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":1449.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W/O DYE","code_information":[{"code":"Px00061010239","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":4141.0,"discounted_cash":1449.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST UNILATERAL","code_information":[{"code":"Px00061010279","type":"CDM"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":3185.0,"discounted_cash":1114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST BILATERAL","code_information":[{"code":"Px00061010280","type":"CDM"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":4013.0,"discounted_cash":1404.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL","code_information":[{"code":"Px00061010281","type":"CDM"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":3856.0,"discounted_cash":1349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL","code_information":[{"code":"Px00061010282","type":"CDM"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":4678.0,"discounted_cash":1637.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN STEM W/O DYE","code_information":[{"code":"Px00061110001","type":"CDM"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":5913.0,"discounted_cash":2069.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE","code_information":[{"code":"Px00061110007","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2232.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE W/FIDUCIAL MRKRS","code_information":[{"code":"Px00061110010","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2232.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE W/O FIDUCIAL MRKRS","code_information":[{"code":"Px00061110011","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2232.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/O & W/DYE","code_information":[{"code":"Px00061110015","type":"CDM"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":7537.0,"discounted_cash":2637.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE","code_information":[{"code":"Px00061210001","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":5913.0,"discounted_cash":2069.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210002","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":5913.0,"discounted_cash":2069.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/DYE","code_information":[{"code":"Px00061210003","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2232.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O DYE","code_information":[{"code":"Px00061210005","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":6225.0,"discounted_cash":2178.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/DYE","code_information":[{"code":"Px00061210007","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":6717.0,"discounted_cash":2350.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE","code_information":[{"code":"Px00061210009","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":6225.0,"discounted_cash":2178.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/DYE","code_information":[{"code":"Px00061210011","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":6717.0,"discounted_cash":2350.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE","code_information":[{"code":"Px00061210013","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":7053.0,"discounted_cash":2468.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O & W/DYE","code_information":[{"code":"Px00061210015","type":"CDM"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":7427.0,"discounted_cash":2599.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O & W/DYE","code_information":[{"code":"Px00061210017","type":"CDM"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":7427.0,"discounted_cash":2599.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MRA PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061210028","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3514.0,"discounted_cash":1229.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MR ANGIO PELVIS W/DYE","code_information":[{"code":"Px00061810001","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3514.0,"discounted_cash":1229.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIO RECOVERY MAJOR","code_information":[{"code":"Px00071010103","type":"CDM"}],"standard_charges":[{"gross_charge":2508.0,"discounted_cash":877.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ANGIO RECOVERY MINOR","code_information":[{"code":"Px00071010104","type":"CDM"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS I - 1ST HOUR","code_information":[{"code":"Px00071010109","type":"CDM"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS I - ADDL 15 MIN","code_information":[{"code":"Px00071010110","type":"CDM"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS II - 1ST HOUR","code_information":[{"code":"Px00071010113","type":"CDM"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":454.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS II - ADDL 15 MIN","code_information":[{"code":"Px00071010114","type":"CDM"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS III - 1ST HOUR","code_information":[{"code":"Px00071010117","type":"CDM"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS III - ADDL 15 MIN","code_information":[{"code":"Px00071010118","type":"CDM"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS IV - 1ST HOUR","code_information":[{"code":"Px00071010120","type":"CDM"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS IV - ADDL 15 MIN","code_information":[{"code":"Px00071010121","type":"CDM"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS V - 1ST HOUR","code_information":[{"code":"Px00071010124","type":"CDM"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":656.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC RECOVERY CLASS V - ADDL 15 MIN","code_information":[{"code":"Px00071010125","type":"CDM"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL 15","code_information":[{"code":"Px00071010131","type":"CDM"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 INITIAL 15","code_information":[{"code":"Px00071010132","type":"CDM"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 INITIAL 15","code_information":[{"code":"Px00071010133","type":"CDM"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 INITIAL 15","code_information":[{"code":"Px00071010134","type":"CDM"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":158.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 INITIAL 15","code_information":[{"code":"Px00071010135","type":"CDM"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":171.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 PER MIN","code_information":[{"code":"Px00071010231","type":"CDM"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":5.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 PER MIN","code_information":[{"code":"Px00071010232","type":"CDM"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 PER MIN","code_information":[{"code":"Px00071010233","type":"CDM"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 PER MIN","code_information":[{"code":"Px00071010234","type":"CDM"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 PER MIN","code_information":[{"code":"Px00071010358","type":"CDM"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 1 CDM","code_information":[{"code":"Px00072210001","type":"CDM"}],"standard_charges":[{"gross_charge":6592.0,"discounted_cash":2307.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 2 CDM","code_information":[{"code":"Px00072210002","type":"CDM"}],"standard_charges":[{"gross_charge":7237.0,"discounted_cash":2532.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 3 CDM","code_information":[{"code":"Px00072210003","type":"CDM"}],"standard_charges":[{"gross_charge":14954.0,"discounted_cash":5233.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 4 CDM","code_information":[{"code":"Px00072210004","type":"CDM"}],"standard_charges":[{"gross_charge":16106.0,"discounted_cash":5637.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CIRCUMCISION W/REGIONL BLOCK CDM","code_information":[{"code":"Px00072310001","type":"CDM"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.0,"discounted_cash":1081.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECG 12 LEAD TRACING ONLY","code_information":[{"code":"Px00073010002","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":195.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ECG/SIGNAL-AVERAGED","code_information":[{"code":"Px00073010004","type":"CDM"},{"code":"93278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EXTERNAL ECG REC/ GT 48 HRS/ UP TO 7DAYS RECORDING CDM","code_information":[{"code":"Px00073100003","type":"CDM"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HOLTER MONITOR UP TO 48 HRS","code_information":[{"code":"Px00073110001","type":"CDM"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HOLTER MONITOR ANALYSIS & REPT","code_information":[{"code":"Px00073110002","type":"CDM"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2486.0,"discounted_cash":870.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIAC EVENT MONITOR SET UP","code_information":[{"code":"Px00073210001","type":"CDM"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":44.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MULTIPLE SLEEP LATENCY TEST","code_information":[{"code":"Px00074010002","type":"CDM"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1623.0,"discounted_cash":568.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG EXTENDED MONITORING 61-119 MINUTES","code_information":[{"code":"Px00074010014","type":"CDM"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.0,"discounted_cash":705.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","code_information":[{"code":"Px00074010015","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1604.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00074010018","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.0,"discounted_cash":705.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG COMA OR SLEEP ONLY","code_information":[{"code":"Px00074010020","type":"CDM"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.0,"discounted_cash":537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG CEREBRAL DEATH ONLY","code_information":[{"code":"Px00074010022","type":"CDM"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":2152.0,"discounted_cash":753.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEUROLOGICAL PROCEDURE","code_information":[{"code":"Px00074010034","type":"CDM"},{"code":"95999","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG- SSEP UPPERS & LOWERS","code_information":[{"code":"Px00074010044","type":"CDM"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":7008.0,"discounted_cash":2452.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MOTOR EVOKED UPR&LWR LIMBS","code_information":[{"code":"Px00074010045","type":"CDM"},{"code":"95939","type":"HCPCS"}],"standard_charges":[{"gross_charge":6960.0,"discounted_cash":2436.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS CDM","code_information":[{"code":"Px00074010057","type":"CDM"},{"code":"95700","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":322.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED CDM","code_information":[{"code":"Px00074010058","type":"CDM"},{"code":"95705","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":322.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR CDM","code_information":[{"code":"Px00074010059","type":"CDM"},{"code":"95706","type":"HCPCS"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS R-T MNTR CDM","code_information":[{"code":"Px00074010060","type":"CDM"},{"code":"95707","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED CDM","code_information":[{"code":"Px00074010061","type":"CDM"},{"code":"95708","type":"HCPCS"}],"standard_charges":[{"gross_charge":1853.0,"discounted_cash":648.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR CDM","code_information":[{"code":"Px00074010062","type":"CDM"},{"code":"95709","type":"HCPCS"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":971.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG W/O VID TECH EA INCR 12-26 HR CONT R-T MNTR CDM","code_information":[{"code":"Px00074010063","type":"CDM"},{"code":"95710","type":"HCPCS"}],"standard_charges":[{"gross_charge":3698.0,"discounted_cash":1294.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HOURS UNMONITORED CDM","code_information":[{"code":"Px00074010064","type":"CDM"},{"code":"95711","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING CDM","code_information":[{"code":"Px00074010065","type":"CDM"},{"code":"95712","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":351.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING CDM","code_information":[{"code":"Px00074010066","type":"CDM"},{"code":"95713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1296.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR UNMONITORED CDM","code_information":[{"code":"Px00074010067","type":"CDM"},{"code":"95714","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":680.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR CDM","code_information":[{"code":"Px00074010068","type":"CDM"},{"code":"95715","type":"HCPCS"}],"standard_charges":[{"gross_charge":2910.0,"discounted_cash":1018.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VEEG BY TECH EA INCR 12-26 HR CONT R-T MNTR CDM","code_information":[{"code":"Px00074010069","type":"CDM"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":3882.0,"discounted_cash":1358.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING TRUNK/HEAD","code_information":[{"code":"Px00074010105","type":"CDM"},{"code":"95927","type":"HCPCS"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC C MOTOR EVOKED UPPR LIMBS","code_information":[{"code":"Px00074010106","type":"CDM"},{"code":"95928","type":"HCPCS"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC C MOTOR EVOKED LWR LIMBS","code_information":[{"code":"Px00074010107","type":"CDM"},{"code":"95929","type":"HCPCS"}],"standard_charges":[{"gross_charge":3480.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EEG DURING SURGERY","code_information":[{"code":"Px00074010115","type":"CDM"},{"code":"95955","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":355.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR","code_information":[{"code":"Px00074010120","type":"CDM"},{"code":"95961","type":"HCPCS"}],"standard_charges":[{"gross_charge":5641.0,"discounted_cash":1974.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ELECTRODE STIM BRAIN ADD-ON","code_information":[{"code":"Px00074010121","type":"CDM"},{"code":"95962","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":211.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHOLANGIOSCOPY","code_information":[{"code":"Px00075010009","type":"CDM"}],"standard_charges":[{"gross_charge":10185.0,"discounted_cash":3564.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY SCREENING","code_information":[{"code":"Px00075010014","type":"CDM"}],"standard_charges":[{"gross_charge":6390.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ BIOPSY","code_information":[{"code":"Px00075010015","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ BLEEDING CONT","code_information":[{"code":"Px00075010016","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"Px00075010024","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD CONTROL BLEEDING ANY","code_information":[{"code":"Px00075010025","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY","code_information":[{"code":"Px00075010030","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP","code_information":[{"code":"Px00075010033","type":"CDM"}],"standard_charges":[{"gross_charge":10680.0,"discounted_cash":3738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EUS LINEAR","code_information":[{"code":"Px00075010040","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EUS RADIAL","code_information":[{"code":"Px00075010041","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FLEXIBLE SIGMOIDOSCOPY W/ BIOPOSY","code_information":[{"code":"Px00075010046","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GASTROESOPHAGEAL REFLUX TEST","code_information":[{"code":"Px00075010050","type":"CDM"},{"code":"91034","type":"HCPCS"}],"standard_charges":[{"gross_charge":7779.0,"discounted_cash":2722.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GI TRACT CAPSULE ENDOSCOPY","code_information":[{"code":"Px00075010056","type":"CDM"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":6294.0,"discounted_cash":2202.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC UNLISTED ENDO PROCEDURE","code_information":[{"code":"Px00075010063","type":"CDM"}],"standard_charges":[{"gross_charge":8369.0,"discounted_cash":2929.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ BLEEDING CONTROL","code_information":[{"code":"Px00075010074","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC UPPR GI SCOPE W/SUBMUC INJ","code_information":[{"code":"Px00075010084","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD W/ ABLATION","code_information":[{"code":"Px00075010085","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD VARICES LIGATION","code_information":[{"code":"Px00075010086","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD GUIDE WIRE INSERTION","code_information":[{"code":"Px00075010087","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"Px00075010088","type":"CDM"}],"standard_charges":[{"gross_charge":10680.0,"discounted_cash":3738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CHANGE GASTROSTOMY TUBE","code_information":[{"code":"Px00075010097","type":"CDM"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":281.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY POLP/HOT BX","code_information":[{"code":"Px00075010098","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY POLYP SNARE","code_information":[{"code":"Px00075010099","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY THRU STOMA","code_information":[{"code":"Px00075010100","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ SUBMUC INJ","code_information":[{"code":"Px00075010101","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010102","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"Px00075010106","type":"CDM"}],"standard_charges":[{"gross_charge":7028.0,"discounted_cash":2459.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD DILATE STRICTURE","code_information":[{"code":"Px00075010107","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPH EGD DILATION/LESS THAN 30 MM","code_information":[{"code":"Px00075010108","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP WITH BIOPSY","code_information":[{"code":"Px00075010110","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY DX PROCURE","code_information":[{"code":"Px00075010113","type":"CDM"}],"standard_charges":[{"gross_charge":6390.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010114","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ BALLOON DILATION","code_information":[{"code":"Px00075010115","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ SNARE REMOVAL","code_information":[{"code":"Px00075010118","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP W/ REMOVAL CALCULUS","code_information":[{"code":"Px00075010123","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP W/ SPHINCTER/PAPILLO","code_information":[{"code":"Px00075010124","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPH ENDO DILATION BALLOON/LESS THAN 30 MM","code_information":[{"code":"Px00075010134","type":"CDM"}],"standard_charges":[{"gross_charge":3285.0,"discounted_cash":1149.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD CAUTERY TUMOR POLYP","code_information":[{"code":"Px00075010141","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD REMOVE LESION SNARE","code_information":[{"code":"Px00075010142","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDO CHOLANGIOPANCREATOGRAPH W/ LITHOTRIPSY","code_information":[{"code":"Px00075010149","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DILATE ESOPHAGUS, UNGUIDED","code_information":[{"code":"Px00075010154","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DILATE ESOPHAGUS, OVER GUIDE WIRE","code_information":[{"code":"Px00075010155","type":"CDM"}],"standard_charges":[{"gross_charge":3285.0,"discounted_cash":1149.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, ILEOSCOPY","code_information":[{"code":"Px00075010167","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, ILEOSCOPY W/ BIOPSY","code_information":[{"code":"Px00075010168","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDO ULTRSND UGI W/WO FNA","code_information":[{"code":"Px00075010195","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DILATION","code_information":[{"code":"Px00075010210","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY RIGID TRNSO DX","code_information":[{"code":"Px00075010219","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP RIG TRNSO INJECT","code_information":[{"code":"Px00075010220","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP RIG TRNSO BIOPSY","code_information":[{"code":"Px00075010221","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP RIG TRNSO REM FB","code_information":[{"code":"Px00075010222","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY RIGID BALLOON","code_information":[{"code":"Px00075010223","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCP GUIDE WIRE DILAT","code_information":[{"code":"Px00075010224","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY FLEX DX BRUSH","code_information":[{"code":"Px00075010225","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSC FLEX TRNSN BIOPSY","code_information":[{"code":"Px00075010226","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOP MUCOSAL RESECT","code_information":[{"code":"Px00075010227","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOP STENT PLACEMENT","code_information":[{"code":"Px00075010228","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY RETRO BALLOON","code_information":[{"code":"Px00075010229","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSC DILATE BALLOON 30","code_information":[{"code":"Px00075010230","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY LESION ABLATE","code_information":[{"code":"Px00075010231","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD BALLOON DIL ESOPH30 MM/>","code_information":[{"code":"Px00075010232","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD US TRANSMURAL INJXN/MARK","code_information":[{"code":"Px00075010233","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD ENDO MUCOSAL RESECTION","code_information":[{"code":"Px00075010234","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD ENDOSCOPIC STENT PLACE","code_information":[{"code":"Px00075010235","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC EGD LESION ABLATION","code_information":[{"code":"Px00075010236","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP DUCT STENT PLACEMENT","code_information":[{"code":"Px00075010237","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP REMOVE FORGN BODY DUCT","code_information":[{"code":"Px00075010238","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP STENT EXCHANGE W/DILATE","code_information":[{"code":"Px00075010239","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP EA DUCT/AMPULLA DILATE","code_information":[{"code":"Px00075010240","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ERCP LESION ABLATE W/DILATE","code_information":[{"code":"Px00075010241","type":"CDM"}],"standard_charges":[{"gross_charge":9709.0,"discounted_cash":3398.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY W STENT PLCMNT","code_information":[{"code":"Px00075010246","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY WITH ABLATION THROUGH STOMA","code_information":[{"code":"Px00075010247","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/STENT PLCMT THROUGH STOMA","code_information":[{"code":"Px00075010248","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/RESECTION","code_information":[{"code":"Px00075010249","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/INJECTION","code_information":[{"code":"Px00075010250","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DILATION","code_information":[{"code":"Px00075010251","type":"CDM"}],"standard_charges":[{"gross_charge":7283.0,"discounted_cash":2549.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ULTRASOUND","code_information":[{"code":"Px00075010252","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/NDL ASPIR/BX","code_information":[{"code":"Px00075010253","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DECOMPRESSION THROUGH STOMA","code_information":[{"code":"Px00075010254","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ABLATION","code_information":[{"code":"Px00075010255","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/PLCMT STENT","code_information":[{"code":"Px00075010256","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/RESECTION","code_information":[{"code":"Px00075010257","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SGMDSC W/BAND LIGATION","code_information":[{"code":"Px00075010258","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ABLATION","code_information":[{"code":"Px00075010259","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/STENT PLCMT","code_information":[{"code":"Px00075010260","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/RESECTION THROUGH STOMA","code_information":[{"code":"Px00075010261","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/DECOMPRESSION","code_information":[{"code":"Px00075010262","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/BAND LIGATION","code_information":[{"code":"Px00075010263","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC UNLISTED PROCEDURE COLON","code_information":[{"code":"Px00075010264","type":"CDM"}],"standard_charges":[{"gross_charge":8010.0,"discounted_cash":2803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 6","code_information":[{"code":"Px00075010272","type":"CDM"}],"standard_charges":[{"gross_charge":17104.0,"discounted_cash":5986.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 1","code_information":[{"code":"Px00075010315","type":"CDM"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 2","code_information":[{"code":"Px00075010316","type":"CDM"}],"standard_charges":[{"gross_charge":5671.0,"discounted_cash":1984.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 3","code_information":[{"code":"Px00075010317","type":"CDM"}],"standard_charges":[{"gross_charge":6693.0,"discounted_cash":2342.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 4","code_information":[{"code":"Px00075010318","type":"CDM"}],"standard_charges":[{"gross_charge":8318.0,"discounted_cash":2911.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 5","code_information":[{"code":"Px00075010319","type":"CDM"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":4996.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Base Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 1 CDM","code_information":[{"code":"Px00076100001","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 2 CDM","code_information":[{"code":"Px00076100002","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 3 CDM","code_information":[{"code":"Px00076100003","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1721.0,"discounted_cash":602.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 4 CDM","code_information":[{"code":"Px00076100004","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.0,"discounted_cash":800.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE NEW PATIENT LVL 5 CDM","code_information":[{"code":"Px00076100005","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":2856.0,"discounted_cash":999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC GENETIC COUNSELING SVC EA 30 CDM","code_information":[{"code":"Px00076100237","type":"CDM"},{"code":"96041","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110002","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110003","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110004","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.0,"discounted_cash":335.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110005","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1309.0,"discounted_cash":458.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110006","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":148.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110021","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.0,"discounted_cash":335.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110039","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110040","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110041","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R","code_information":[{"code":"Px00076110077","type":"CDM"},{"code":"92265","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":108.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN CDM","code_information":[{"code":"Px00076110233","type":"CDM"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN CDM","code_information":[{"code":"Px00076110234","type":"CDM"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DILATION OF CERVICAL CANAL","code_information":[{"code":"Px00076110289","type":"CDM"},{"code":"57800","type":"HCPCS"}],"standard_charges":[{"gross_charge":6478.0,"discounted_cash":2267.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CIRCUMCISION NEONATE","code_information":[{"code":"Px00076110291","type":"CDM"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SUBQ INFUSION INITIAL HR W/PUMP SET-UP CDM","code_information":[{"code":"Px00076110303","type":"CDM"},{"code":"96369","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":197.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IRRIGATION IMPLANTED VAD","code_information":[{"code":"Px00076110307","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00076110316","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":460.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","code_information":[{"code":"Px00076110458","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 1 CDM","code_information":[{"code":"Px00076110507","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":201.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 2 CDM","code_information":[{"code":"Px00076110526","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1148.0,"discounted_cash":401.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM","code_information":[{"code":"Px00076110533","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1721.0,"discounted_cash":602.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 4 CDM","code_information":[{"code":"Px00076110534","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.0,"discounted_cash":800.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC L&D TRIAGE ESTAB PATIENT LVL 5 CDM","code_information":[{"code":"Px00076110551","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":2856.0,"discounted_cash":999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HOSPITAL OBSERVATION PER HR CDM","code_information":[{"code":"Px00076210001","type":"CDM"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIRECT REFERRAL TO OBSERVATION CARE CDM","code_information":[{"code":"Px00076210010","type":"CDM"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":472.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC COVID 19 IMMUNIZATION SINGLE DOSE ADMIN CDM","code_information":[{"code":"Px00077100046","type":"CDM"},{"code":"90480","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMM ADMN SARSCOV2 VACCINE EACH ADDL COMPONENT CDM","code_information":[{"code":"Px00077100054","type":"CDM"},{"code":"90481","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN CDM","code_information":[{"code":"Px00077110001","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN EACH ADD CDM","code_information":[{"code":"Px00077110002","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ADMIN INFLUENZA VIRUS VAC CDM","code_information":[{"code":"Px00077110003","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ADMIN PNEUMOCOCCAL VACCINE CDM","code_information":[{"code":"Px00077110004","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ADMIN HEPATITIS B VACCINE CDM","code_information":[{"code":"Px00077110005","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMODIALYSIS IP","code_information":[{"code":"Px00080110006","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":5760.0,"discounted_cash":2016.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD IP","code_information":[{"code":"Px00080310002","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CCPD IP","code_information":[{"code":"Px00080410001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CRRT IP","code_information":[{"code":"Px00080900001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMODIAL OP ER/POSTOP NON ESRD","code_information":[{"code":"Px00082900001","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":6278.0,"discounted_cash":2197.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC HEMODIAL OP ER/POSTOP ESRD","code_information":[{"code":"Px00082910001","type":"CDM"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":6278.0,"discounted_cash":2197.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD OP","code_information":[{"code":"Px00084110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CCPD OP","code_information":[{"code":"Px00085100001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CRRT OP","code_information":[{"code":"Px00088110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":880.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FETAL NON-STRESS TEST CDM","code_information":[{"code":"Px00092010032","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC FETAL CONTRACT STRESS TEST","code_information":[{"code":"Px00092010033","type":"CDM"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 1-2 STUDIES CDM","code_information":[{"code":"Px00092010039","type":"CDM"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"discounted_cash":283.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 3-4 STUDIES CDM","code_information":[{"code":"Px00092010040","type":"CDM"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.0,"discounted_cash":566.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 5-6 STUDIES CDM","code_information":[{"code":"Px00092010041","type":"CDM"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":2666.0,"discounted_cash":933.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 7-8 STUDIES CDM","code_information":[{"code":"Px00092010042","type":"CDM"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":399.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 9-10 STUDIES CDM","code_information":[{"code":"Px00092010043","type":"CDM"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":4522.0,"discounted_cash":1582.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 11-12 STUDIES CDM","code_information":[{"code":"Px00092010044","type":"CDM"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.0,"discounted_cash":721.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NERVE CONDUCTION STUDIES 13/> STUDIES CDM","code_information":[{"code":"Px00092010045","type":"CDM"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":6951.0,"discounted_cash":2432.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","code_information":[{"code":"Px00092010047","type":"CDM"},{"code":"95940","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","code_information":[{"code":"Px00092110002","type":"CDM"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2823.0,"discounted_cash":988.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","code_information":[{"code":"Px00092110003","type":"CDM"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":453.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL","code_information":[{"code":"Px00092110004","type":"CDM"},{"code":"93886","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD","code_information":[{"code":"Px00092110005","type":"CDM"},{"code":"93888","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TCD EMBOL DETECT W/O INJ","code_information":[{"code":"Px00092110006","type":"CDM"},{"code":"93892","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC TCD W MICROBUBBLE INJ CDM","code_information":[{"code":"Px00092110007","type":"CDM"},{"code":"93893","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","code_information":[{"code":"Px00092110008","type":"CDM"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":2752.0,"discounted_cash":963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","code_information":[{"code":"Px00092110009","type":"CDM"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":2752.0,"discounted_cash":963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","code_information":[{"code":"Px00092110010","type":"CDM"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2542.0,"discounted_cash":889.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","code_information":[{"code":"Px00092110011","type":"CDM"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":370.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","code_information":[{"code":"Px00092110012","type":"CDM"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2479.0,"discounted_cash":867.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","code_information":[{"code":"Px00092110013","type":"CDM"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":370.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","code_information":[{"code":"Px00092110015","type":"CDM"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2542.0,"discounted_cash":889.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","code_information":[{"code":"Px00092110016","type":"CDM"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":497.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","code_information":[{"code":"Px00092110017","type":"CDM"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":509.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT","code_information":[{"code":"Px00092110018","type":"CDM"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1155.0,"discounted_cash":404.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","code_information":[{"code":"Px00092110019","type":"CDM"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":477.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PENILE VASCULAR STUDY COMPLETE","code_information":[{"code":"Px00092110021","type":"CDM"},{"code":"93980","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.0,"discounted_cash":732.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN HEMODIALYSIS ACCESS","code_information":[{"code":"Px00092110024","type":"CDM"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":358.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","code_information":[{"code":"Px00092110028","type":"CDM"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":392.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC ART PRESSURE WAVEFORM ANALYS","code_information":[{"code":"Px00092110070","type":"CDM"},{"code":"93050","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210001","type":"CDM"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":324.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210003","type":"CDM"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":1166.0,"discounted_cash":408.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210004","type":"CDM"},{"code":"95863","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.0,"discounted_cash":497.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210005","type":"CDM"},{"code":"95864","type":"HCPCS"}],"standard_charges":[{"gross_charge":1630.0,"discounted_cash":570.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI CDM","code_information":[{"code":"Px00092210007","type":"CDM"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":265.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI CDM","code_information":[{"code":"Px00092210009","type":"CDM"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING UPPER LIMBS","code_information":[{"code":"Px00092210013","type":"CDM"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":3505.0,"discounted_cash":1226.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING LOWER LIMBS","code_information":[{"code":"Px00092210018","type":"CDM"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":3505.0,"discounted_cash":1226.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC VISUAL EVOKED POTENTIAL TEST","code_information":[{"code":"Px00092210020","type":"CDM"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":1130.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEUROMUSCULAR JUNCTION TEST","code_information":[{"code":"Px00092210023","type":"CDM"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12 CDM","code_information":[{"code":"Px00092210029","type":"CDM"},{"code":"95869","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE CDM","code_information":[{"code":"Px00092210030","type":"CDM"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED CDM","code_information":[{"code":"Px00092210031","type":"CDM"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":269.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION CDM","code_information":[{"code":"Px00092210032","type":"CDM"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INDIV IONM REMOTE O.R. EA 15MIN","code_information":[{"code":"Px00092210033","type":"CDM"},{"code":"G0453","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC NEEDLE ELECTROMYOGRAPHY LARYNX CDM","code_information":[{"code":"Px00092210063","type":"CDM"},{"code":"95865","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BEHAV CHNG SMOKING 3-10 MIN","code_information":[{"code":"Px00094010003","type":"CDM"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC BEHAV CHNG SMOKING > 10 MIN","code_information":[{"code":"Px00094010004","type":"CDM"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":136.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION","code_information":[{"code":"Px00094010006","type":"CDM"},{"code":"93668","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":119.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSERT STRAIGHT CATH BLADDER","code_information":[{"code":"Px00094010050","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","code_information":[{"code":"Px00094010051","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER/PROPH/DIAG INJ INTRA-ARTERIAL CDM","code_information":[{"code":"Px00094010061","type":"CDM"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":231.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THERAPUTIC PHLEBOTOMY","code_information":[{"code":"Px00094010204","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":316.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ SQ OR IM CDM","code_information":[{"code":"Px00094010205","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ IV PUSH INITIAL DRUG CDM","code_information":[{"code":"Px00094010207","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":214.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC INJ IV PUSH SEQUENTIAL NEW DRUG CDM","code_information":[{"code":"Px00094010208","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC CDM","code_information":[{"code":"Px00094010209","type":"CDM"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00094210001","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210013","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 97802 MED NUTRITION INDIV INIT EA 15 MIN CDM","code_information":[{"code":"Px00094210014","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE 97803 MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210015","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS PHONE G0108 DIAB MAN TRN PER INDIV 30 MIN CDM","code_information":[{"code":"Px00094210022","type":"CDM"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH G0108 DIAB MAN TRN PER INDIV 30 MIN CDM","code_information":[{"code":"Px00094210025","type":"CDM"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97802 MEDICAL NUTRITION INDIV INIT THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00094210044","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97803 MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210045","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIAB MANAGE TRN PER INDIV 30 MIN CDM","code_information":[{"code":"Px00094210071","type":"CDM"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC DIAB MANAGE TRN GROUP 30 MIN CDM","code_information":[{"code":"Px00094210088","type":"CDM"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIAC REHAB NON MONITOR PHASE 2","code_information":[{"code":"Px00094310001","type":"CDM"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC CARDIAC REHAB/MONITOR PHASE 2","code_information":[{"code":"Px00094310023","type":"CDM"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR CDM","code_information":[{"code":"Px00094800001","type":"CDM"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR CDM","code_information":[{"code":"Px00094800002","type":"CDM"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION (Unit Price)"}]},{"description":"SOTALOL 5 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx0000-0032-2","type":"CDM"},{"code":"0000-0032-26","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRISMASATE BK 0/3.5 DIALYSIS SOLUTION","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000000000","type":"CDM"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRISMASATE BGK 2/0 DIALYSIS SOLUTION","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx00000000000","type":"CDM"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL-BUPIVACAINE 2 MCG-0.125%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000000004","type":"CDM"},{"code":"00000000004","type":"NDC"}],"standard_charges":[{"gross_charge":153.2,"discounted_cash":53.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE 5 MG/ML SUSPENSION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000008","type":"CDM"},{"code":"00000000008","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE ORAL SUSP 1 MG/ML (CMPD KIT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000000009","type":"CDM"},{"code":"00000000009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE 10 MCG/ML SUSPENSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000018","type":"CDM"},{"code":"00000000018","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE 25 MCG/ML SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000023","type":"CDM"},{"code":"00000000023","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ACETATE LIQUID 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000024","type":"CDM"},{"code":"00000000024","type":"NDC"}],"standard_charges":[{"gross_charge":3.51,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM PHOSPHATE LIQUID 3 MMOL/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000026","type":"CDM"},{"code":"00000000026","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM ACETATE LIQUID 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000028","type":"CDM"},{"code":"00000000028","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE SUSP 25 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000000035","type":"CDM"},{"code":"00000000035","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"URSODIOL 20 MG/ML SUSPENSION","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000000036","type":"CDM"},{"code":"00000000036","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE 1 MG/ML SUSPENSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000041","type":"CDM"},{"code":"00000000041","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOLN PREF SYR 10 MCG/ML,EPINEPHRINE HCL-NACL IV SOLN PREF SYR 50 MCG/5ML-0.9%,EPINEPHRINE HCL-NACL IV SOLN PREF SYR 100 MCG/10ML-0.9%,EPINEPHRINE HCL-NACL IV SOL PREF SYR 200 MCG/20ML-0.9%,EPINEPHRINE HCL-NACL IV SOL PREF SYR 500 MCG/50ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 0.1 MG/10ML (10 MCG/ML),EPINEPHRINE-DEXTROSE IV SOLN PREF SYR 100 MCG/10ML-5%,EPINEPHRINE BITART-NACL IV SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000056","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000000056","type":"NDC"}],"standard_charges":[{"gross_charge":93.95,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE 400 MCG IN 100 ML NS INFUSION ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000153","type":"CDM"},{"code":"00000000153","type":"NDC"}],"standard_charges":[{"gross_charge":1338.75,"discounted_cash":468.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILDENAFIL 2.5 MG/ML SUSPENSION","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000000181","type":"CDM"},{"code":"00000000181","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOMYCIN INTRAOCULAR SOLN PREF SYRINGE 0.03% (0.3 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000000195","type":"CDM"},{"code":"J7315","type":"HCPCS"},{"code":"00000000195","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL 20 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000000220","type":"CDM"},{"code":"00000000220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN ORAL SUSP 5 MG/ML,BACLOFEN ORAL SUSP 5 MG/ML (CMPD KIT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000221","type":"CDM"},{"code":"00000000221","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL 1 MG/ML SUSPENSION","drug_information":{"unit":3.125,"type":"ML"},"code_information":[{"code":"Rx00000000258","type":"CDM"},{"code":"00000000258","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INJECTION FOR ORAL USE","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000259","type":"CDM"},{"code":"00000000259","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 100 MG/ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 2 GM/20ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 1 GM/10ML,CEFAZOLIN SODIUM INJ SOLN PREF SYRINGE 3 GM/30ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000304","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000304","type":"NDC"}],"standard_charges":[{"gross_charge":94.3,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 100 MG/ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 2 GM/20ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 1 GM/10ML,CEFAZOLIN SODIUM INJ SOLN PREF SYRINGE 3 GM/30ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000305","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000305","type":"NDC"}],"standard_charges":[{"gross_charge":95.35,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFOXITIN 100 MG/ML IV SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000310","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00000000310","type":"NDC"}],"standard_charges":[{"gross_charge":97.17,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME 100 MG/ML IV SYRINGE","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000000314","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00000000314","type":"NDC"}],"standard_charges":[{"gross_charge":95.99,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NICARDIPINE HCL-SODIUM CHLORIDE IV SOLN 50 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000000324","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00000000324","type":"NDC"}],"standard_charges":[{"gross_charge":524.76,"discounted_cash":183.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ON-Q PUMP (C-BLOC) BAG 5 ML/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000334","type":"CDM"},{"code":"C9804","type":"HCPCS"},{"code":"00000000334","type":"NDC"}],"standard_charges":[{"gross_charge":633.9,"discounted_cash":221.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ 10 MG/ML,MORPHINE SULFATE INJ 5 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 10 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 8 MG/ML,MORPHINE SULFATE IV SOLN PF 8 MG/ML,MORPHINE SULFATE-NACL PF SOL PREF SYR 0.5 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 1 MG/ML-0.9%,MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE INJ PF 5 MG/ML,MORPHINE SULFATE INJ PF 8 MG/ML,MORPHINE SULFATE INJ PF 10 MG/ML,MORPHINE SULFATE INJ 1 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 4 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 8 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML,MORPHINE SULFATE IV SOLN 0.5 MG/ML,MORPHINE SULFATE IV SOLN 10 MG/ML,MORPHINE SULFATE-NACL INJ SOLN PREF SYR 2 MG/2ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000338","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000000338","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML,MEPERIDINE HCL INJ 50 MG/ML,MEPERIDINE HCL INJ 100 MG/ML,MEPERIDINE HCL INJ 75 MG/ML,MEPERIDINE HCL INJ 25 MG/0.5ML (50 MG/ML),MEPERIDINE HCL INJ 100 MG/2ML (50 MG/ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000339","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00000000339","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML,LORAZEPAM INJ 4 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000340","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00000000340","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS 0.5 MG/ML SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000359","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00000000359","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 100 MG/ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 2 GM/20ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 1 GM/10ML,CEFAZOLIN SODIUM INJ SOLN PREF SYRINGE 3 GM/30ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000378","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000378","type":"NDC"}],"standard_charges":[{"gross_charge":94.3,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE 8 MG IN 500 ML NS INFUSION ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000000439","type":"CDM"},{"code":"00000000439","type":"NDC"}],"standard_charges":[{"gross_charge":96.25,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 100 MG/ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 2 GM/20ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 1 GM/10ML,CEFAZOLIN SODIUM INJ SOLN PREF SYRINGE 3 GM/30ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000526","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000526","type":"NDC"}],"standard_charges":[{"gross_charge":96.4,"discounted_cash":33.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE LIQUID 0.4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000530","type":"CDM"},{"code":"00000000530","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ON-Q PUMP (C-BLOC) BAG SELECT-A-FLOW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000535","type":"CDM"},{"code":"C9804","type":"HCPCS"},{"code":"00000000535","type":"NDC"}],"standard_charges":[{"gross_charge":648.64,"discounted_cash":227.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE 25 MG/ML ORAL SUSPENSION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000537","type":"CDM"},{"code":"00000000537","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZATHIOPRINE 50 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000000539","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00000000539","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOLIC ACID 1 MG/ML ORAL LIQUID","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00000000541","type":"CDM"},{"code":"00000000541","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx00000000545","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00000000545","type":"NDC"}],"standard_charges":[{"gross_charge":95.37,"discounted_cash":33.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYTOCIN-LACTATED RINGERS IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000000645","type":"CDM"},{"code":"00000000645","type":"NDC"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE 10 MG/ML PO SOLN (FROM INJ)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000000681","type":"CDM"},{"code":"00000000681","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN 25 MG/ML PO SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000682","type":"CDM"},{"code":"00000000682","type":"NDC"}],"standard_charges":[{"gross_charge":6.94,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL 10 MG/ML PO LIQD","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000000725","type":"CDM"},{"code":"00000000725","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000000759","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00000000759","type":"NDC"}],"standard_charges":[{"gross_charge":96.77,"discounted_cash":33.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000000838","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00000000838","type":"NDC"}],"standard_charges":[{"gross_charge":198.73,"discounted_cash":69.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SHUGARCAINE (1.5ML OF 2% LIDOCAINE (PF) W/ 4.5ML BSS) W/ EPINEPHRINE 1ML (1:1000) PF/BISULFITE FREE","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"Rx00000001431","type":"CDM"},{"code":"00000001431","type":"NDC"}],"standard_charges":[{"gross_charge":203.84,"discounted_cash":71.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALACYCLOVIR 50MG/ML (COMPOUND) PO SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000001519","type":"CDM"},{"code":"00000001519","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALTEPLASE CATH DECLOT IN SW INJ 0.5MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000001532","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001532","type":"NDC"}],"standard_charges":[{"gross_charge":465.58,"discounted_cash":162.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000001538","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000001538","type":"NDC"}],"standard_charges":[{"gross_charge":246.78,"discounted_cash":86.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001552","type":"CDM"},{"code":"00000001552","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALTEPLASE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001553","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"00000001553","type":"NDC"}],"standard_charges":[{"gross_charge":890.73,"discounted_cash":311.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL 12 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000001635","type":"CDM"},{"code":"00000001635","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYUREA 100 MG/ML SUSPENSION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000001637","type":"CDM"},{"code":"00000001637","type":"NDC"}],"standard_charges":[{"gross_charge":28.35,"discounted_cash":9.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARDIOPLEGIC SOLN","drug_information":{"unit":810.0,"type":"ML"},"code_information":[{"code":"Rx00000001748","type":"CDM"},{"code":"00000001748","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OMEPRAZOLE-SODIUM BICARBONATE 2 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000001774","type":"CDM"},{"code":"00000001774","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN 1 G WITH GENT 80 MG IN 1 L NS ONE STEP","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000001776","type":"CDM"},{"code":"00000001776","type":"NDC"}],"standard_charges":[{"gross_charge":113.9,"discounted_cash":39.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPYRIDAMOLE IN NS 60MG/40ML INJ (SIMPLE)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00000001860","type":"CDM"},{"code":"J1245","type":"HCPCS"},{"code":"00000001860","type":"NDC"}],"standard_charges":[{"gross_charge":95.17,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.05% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001871","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001871","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL-NACL INJ SOLN PREF SYR 0.0625-0.9% (50 ML)","drug_information":{"unit":5.6,"type":"ML"},"code_information":[{"code":"Rx00000001872","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001872","type":"NDC"}],"standard_charges":[{"gross_charge":93.93,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.075% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001873","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001873","type":"NDC"}],"standard_charges":[{"gross_charge":93.86,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.1% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001874","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001874","type":"NDC"}],"standard_charges":[{"gross_charge":93.86,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.125% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.2,"type":"ML"},"code_information":[{"code":"Rx00000001875","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001875","type":"NDC"}],"standard_charges":[{"gross_charge":93.88,"discounted_cash":32.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OMEPRAZOLE-SODIUM BICARBONATE 2 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000001881","type":"CDM"},{"code":"00000001881","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FILGRASTIM 20 MCG/ML INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001967","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"00000001967","type":"NDC"}],"standard_charges":[{"gross_charge":176.99,"discounted_cash":61.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID 1 G IN 50 ML NS IVPB ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002165","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000002165","type":"NDC"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000002200","type":"CDM"},{"code":"00000002200","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) 100 UNT/ML IN SODIUM CHLORIDE 0.45% SYRINGE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002362","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000002362","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPHEDRINE SULF-NACL SOLN PREF SYR 10 MG/ML-0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000002425","type":"CDM"},{"code":"00000002425","type":"NDC"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 80 MCG/20ML,DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 200 MCG/50ML,DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000002464","type":"CDM"},{"code":"00000002464","type":"NDC"}],"standard_charges":[{"gross_charge":127.68,"discounted_cash":44.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"},{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BSS 2.25ML + LIDOCAINE PF 2% 0.75ML + EPINEPHRINE (1:1000) 1ML ONE STEP","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000002465","type":"CDM"},{"code":"00000002465","type":"NDC"}],"standard_charges":[{"gross_charge":102.51,"discounted_cash":35.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000002553","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00000002553","type":"NDC"}],"standard_charges":[{"gross_charge":103.19,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE 10% (100 MG/ML) INJECTION FOR ORAL USE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000002606","type":"CDM"},{"code":"00000002606","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLECAINIDE 20 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000002624","type":"CDM"},{"code":"00000002624","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000002737","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000002737","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE POWDER","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00000002848","type":"CDM"},{"code":"00000002848","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 5% IV SOLN 900 MG/500ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002877","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000002877","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL 25 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003026","type":"CDM"},{"code":"00000003026","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003031","type":"CDM"},{"code":"00000003031","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | NDC EA = 1 TABLET"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003035","type":"CDM"},{"code":"00000003035","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOMYCIN 0.3 MG/ML FOR TOPICAL APPLICATION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003190","type":"CDM"},{"code":"00000003190","type":"NDC"}],"standard_charges":[{"gross_charge":59.02,"discounted_cash":20.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL 1 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003193","type":"CDM"},{"code":"00000003193","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CANDESARTAN 1 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003194","type":"CDM"},{"code":"00000003194","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE 5 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003200","type":"CDM"},{"code":"00000003200","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISRADIPINE 1 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003210","type":"CDM"},{"code":"00000003210","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL 40 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003212","type":"CDM"},{"code":"00000003212","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL 1 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003213","type":"CDM"},{"code":"00000003213","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN 2.5 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003215","type":"CDM"},{"code":"00000003215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOLAZONE 1 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003216","type":"CDM"},{"code":"00000003216","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAPROXEN 25 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003218","type":"CDM"},{"code":"00000003218","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE 4 MG/ML ORAL SUSPENSION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003219","type":"CDM"},{"code":"00000003219","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIMODIPINE 30 MG/ML (CONCENTRATE) PO LIQUID","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000003220","type":"CDM"},{"code":"00000003220","type":"NDC"}],"standard_charges":[{"gross_charge":14.04,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL 125 MG/125ML IN DEXTROSE 5% IV SOLN (1 MG/ML)","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx00000003252","type":"CDM"},{"code":"00000003252","type":"NDC"}],"standard_charges":[{"gross_charge":244.89,"discounted_cash":85.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL SOLUTION PREFILLED SYRINGE 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003295","type":"CDM"},{"code":"J1230","type":"HCPCS"},{"code":"00000003295","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.5% SNGL LUMN ON-Q PUMP 270 ML","drug_information":{"unit":270.0,"type":"ML"},"code_information":[{"code":"Rx00000003321","type":"CDM"},{"code":"00000003321","type":"NDC"}],"standard_charges":[{"gross_charge":181.44,"discounted_cash":63.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL INJ 2 MG/ML,HYDROMORPHONE HCL INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 2 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.2 MG/0.2ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/0.5ML-0.9%,HYDROMORPHONE HCL INJ 0.5 MG/ML,HYDROMORPHONE HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003352","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000003352","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) IN NACL 0.9% IV SOLN 100 UNIT/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003429","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000003429","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003479","type":"CDM"},{"code":"00000003479","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | NDC EA = 1 TABLET"}]},{"description":"MITOMYCIN 0.4 MG/ML FOR TOPICAL APPLICATION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003537","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000003537","type":"NDC"}],"standard_charges":[{"gross_charge":51.96,"discounted_cash":18.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLN (CHILLED NS)","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000003583","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00000003583","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000003645","type":"CDM"},{"code":"00000003645","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"1:1 BUPIVACAINE 0.5%-EPI 1:200000 WITH LIDOCAINE 1% ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003707","type":"CDM"},{"code":"00000003707","type":"NDC"}],"standard_charges":[{"gross_charge":118.6,"discounted_cash":41.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003908","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000003908","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.5% DBL LUMN ON-Q PUMP 400 ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00000003986","type":"CDM"},{"code":"00000003986","type":"NDC"}],"standard_charges":[{"gross_charge":215.04,"discounted_cash":75.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004000","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004000","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004001","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004001","type":"NDC"}],"standard_charges":[{"gross_charge":93.31,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004002","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004002","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004003","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004003","type":"NDC"}],"standard_charges":[{"gross_charge":93.27,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004005","type":"CDM"},{"code":"00000004005","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004008","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004008","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004009","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004009","type":"NDC"}],"standard_charges":[{"gross_charge":93.4,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00000004010","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004010","type":"NDC"}],"standard_charges":[{"gross_charge":94.39,"discounted_cash":33.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004011","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004011","type":"NDC"}],"standard_charges":[{"gross_charge":93.4,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004012","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004012","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004014","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004014","type":"NDC"}],"standard_charges":[{"gross_charge":93.29,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004015","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004015","type":"NDC"}],"standard_charges":[{"gross_charge":93.55,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004016","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004016","type":"NDC"}],"standard_charges":[{"gross_charge":93.26,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00000004017","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004017","type":"NDC"}],"standard_charges":[{"gross_charge":93.36,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":2.01481481481481,"type":"ML"},"code_information":[{"code":"Rx00000004020","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004020","type":"NDC"}],"standard_charges":[{"gross_charge":93.28,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":1.51111111111111,"type":"ML"},"code_information":[{"code":"Rx00000004021","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004021","type":"NDC"}],"standard_charges":[{"gross_charge":93.47,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 2500 UNIT/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000004056","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00000004056","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE-NACL SOLN PREF SYR 50 MCG/5ML-0.9%,FENTANYL CITRATE-NACL SOLN PREF SYR 10 MCG/ML-0.9%,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 50 MCG/5ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 20 MCG/2ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 10 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004123","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000004123","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004132","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004132","type":"NDC"}],"standard_charges":[{"gross_charge":93.26,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004135","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004135","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004136","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004136","type":"NDC"}],"standard_charges":[{"gross_charge":93.27,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004137","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004137","type":"NDC"}],"standard_charges":[{"gross_charge":240.65,"discounted_cash":84.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004138","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004138","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004140","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004140","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/500ML-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000004210","type":"CDM"},{"code":"00000004210","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN 200 MCG/ML IN D5W 10 ML - ONE STEP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004233","type":"CDM"},{"code":"00000004233","type":"NDC"}],"standard_charges":[{"gross_charge":93.48,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004250","type":"CDM"},{"code":"00000004250","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE/AQUAPHOR DIAPER OINTMENT","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00000004251","type":"CDM"},{"code":"00000004251","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL SOLN PREF SYR 20 UNIT/20ML-0.45%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004253","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"00000004253","type":"NDC"}],"standard_charges":[{"gross_charge":93.42,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN LOCK FLUSH 1 UNIT/ML (1/4 NS) IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004254","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"00000004254","type":"NDC"}],"standard_charges":[{"gross_charge":93.42,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL 4 MG SL SUBL CUSTOM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004255","type":"CDM"},{"code":"00000004255","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL 2.5 MG PO TABS CUSTOM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004256","type":"CDM"},{"code":"00000004256","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE 1 % PO SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004257","type":"CDM"},{"code":"00000004257","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004259","type":"CDM"},{"code":"00000004259","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL 100 MCG/ML IN NS 10 ML - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004260","type":"CDM"},{"code":"00000004260","type":"NDC"}],"standard_charges":[{"gross_charge":220.41,"discounted_cash":77.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE 10 MCG/ML IN NS 10 ML - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004266","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00000004266","type":"NDC"}],"standard_charges":[{"gross_charge":94.25,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004267","type":"CDM"},{"code":"00000004267","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN REGULAR 0.2 UNIT/ML IN NS INJ INTERMITTENT","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000004363","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000004363","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004655","type":"CDM"},{"code":"J7604","type":"HCPCS"},{"code":"00000004655","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000004665","type":"CDM"},{"code":"00000004665","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004669","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00000004669","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN,LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN 4-0.05-0.5%,LIDOCAINE-RACEPINEPHRINE-TETRACAINE EXTERNAL SOL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004709","type":"CDM"},{"code":"00000004709","type":"NDC"}],"standard_charges":[{"gross_charge":94.3,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOMYCIN INTRAOCULAR SOLN PREF SYRINGE 0.04% (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004744","type":"CDM"},{"code":"00000004744","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004815","type":"CDM"},{"code":"00000004815","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL ELIXIR 20 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00000004818","type":"CDM"},{"code":"00000004818","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN ADD-EASE SIMPLE 600 MG","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005016","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000005016","type":"NDC"}],"standard_charges":[{"gross_charge":1941.84,"discounted_cash":679.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN 200 MCG/ML SYRINGE ONE STEP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000005067","type":"CDM"},{"code":"00000005067","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx00000005068","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000005068","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx00000005070","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000005070","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.25% SINGLE LUMEN ON-Q PUMP 400 ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00000005077","type":"CDM"},{"code":"00000005077","type":"NDC"}],"standard_charges":[{"gross_charge":215.04,"discounted_cash":75.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.25% SINGLE LUMN ON-Q PUMP 400 ML VARIABLE FLOW","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00000005078","type":"CDM"},{"code":"00000005078","type":"NDC"}],"standard_charges":[{"gross_charge":215.04,"discounted_cash":75.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000005080","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00000005080","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000005118","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000005118","type":"NDC"}],"standard_charges":[{"gross_charge":154.7,"discounted_cash":54.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000005139","type":"CDM"},{"code":"00000005139","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL IV SOLN 150 MG/30ML (BASE EQUIVALENT),MIDAZOLAM HCL IV SOLN PREFILLED SYRINGE 150 MG/30ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005229","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000005229","type":"NDC"}],"standard_charges":[{"gross_charge":254.88,"discounted_cash":89.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIV-EPI-CLONID-KETOROLAC PREF SYR 123-0.25-0.04-15 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000005455","type":"CDM"},{"code":"00000005455","type":"NDC"}],"standard_charges":[{"gross_charge":246.4,"discounted_cash":86.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 25 MG/ML PO SUSP","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000005605","type":"CDM"},{"code":"00000005605","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOPINAVIR-RITONAVIR SOLN 400-100 MG/5ML (80-20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000005608","type":"CDM"},{"code":"00000005608","type":"NDC"}],"standard_charges":[{"gross_charge":19.48,"discounted_cash":6.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 25 MG/ML PO SUSP","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000005609","type":"CDM"},{"code":"00000005609","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE 0.5 MEQ/ML ORAL LIQUID","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005758","type":"CDM"},{"code":"00000005758","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRAZINAMIDE 100 MG/ML ORAL SUSPENSION","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000005759","type":"CDM"},{"code":"00000005759","type":"NDC"}],"standard_charges":[{"gross_charge":70.56,"discounted_cash":24.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML ORAL LIQUID","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000005761","type":"CDM"},{"code":"00000005761","type":"NDC"}],"standard_charges":[{"gross_charge":628.65,"discounted_cash":220.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"STUDY-NERINETIDE/PLACEBO 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005930","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000005930","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.0035,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000005953","type":"CDM"},{"code":"00000005953","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":55.0,"type":"ML"},"code_information":[{"code":"Rx00000005976","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000005976","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN 25 MG/ML PO SUSP","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx00000006042","type":"CDM"},{"code":"00000006042","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000006046","type":"CDM"},{"code":"00000006046","type":"NDC"}],"standard_charges":[{"gross_charge":93.26,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM INJ 60000 UNIT/ML IN DEXTROSE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006266","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000006266","type":"NDC"}],"standard_charges":[{"gross_charge":243.1,"discounted_cash":85.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006406","type":"CDM"},{"code":"00000006406","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN GLARGINE-YFGN INJ 100 UNIT/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00000006723","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00000006723","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL 50 MG/ML ORAL SUSPENSION","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00000006737","type":"CDM"},{"code":"00000006737","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006791","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006791","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000006792","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006792","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000006793","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006793","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006856","type":"CDM"},{"code":"00000006856","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006857","type":"CDM"},{"code":"00000006857","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006858","type":"CDM"},{"code":"00000006858","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006859","type":"CDM"},{"code":"00000006859","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"Rx00000006860","type":"CDM"},{"code":"00000006860","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":64.0,"type":"ML"},"code_information":[{"code":"Rx00000006861","type":"CDM"},{"code":"00000006861","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":32.0,"type":"ML"},"code_information":[{"code":"Rx00000006862","type":"CDM"},{"code":"00000006862","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":31.25,"type":"ML"},"code_information":[{"code":"Rx00000006863","type":"CDM"},{"code":"00000006863","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN 200 MCG/ML IN D5W 10 ML - ONE STEP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000008214","type":"CDM"},{"code":"00000008214","type":"NDC"}],"standard_charges":[{"gross_charge":93.3,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN 1 MG/ML ORAL SOLUTION","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000008311","type":"CDM"},{"code":"00000008311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002323560","type":"CDM"},{"code":"00002323560","type":"NDC"}],"standard_charges":[{"gross_charge":11.46,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002324001","type":"CDM"},{"code":"00002324001","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002327001","type":"CDM"},{"code":"00002327001","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002416530","type":"CDM"},{"code":"00002416530","type":"NDC"}],"standard_charges":[{"gross_charge":9.24,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BARICITINIB TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002447930","type":"CDM"},{"code":"00002447930","type":"NDC"}],"standard_charges":[{"gross_charge":249.93,"discounted_cash":87.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML,INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL),INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002751017","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751017","type":"NDC"}],"standard_charges":[{"gross_charge":20.41,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN LISPRO PROT & LISPRO INJ 100 UNIT/ML (75-25)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002751101","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751101","type":"NDC"}],"standard_charges":[{"gross_charge":431.22,"discounted_cash":150.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN LISPRO PROTAMINE & LISPRO INJ 100 UNIT/ML (50-50)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002751201","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751201","type":"NDC"}],"standard_charges":[{"gross_charge":431.37,"discounted_cash":150.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN LISPRO SOLN CARTRIDGE 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002751601","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751601","type":"NDC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002821501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"gross_charge":242.3,"discounted_cash":84.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002821517","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002821517","type":"NDC"}],"standard_charges":[{"gross_charge":9.63,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002831501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002831501","type":"NDC"}],"standard_charges":[{"gross_charge":242.3,"discounted_cash":84.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002871501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002871501","type":"NDC"}],"standard_charges":[{"gross_charge":242.3,"discounted_cash":84.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002871517","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002871517","type":"NDC"}],"standard_charges":[{"gross_charge":9.63,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 10 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00003049420","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00003049420","type":"NDC"}],"standard_charges":[{"gross_charge":93.8,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"APIXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089331","type":"CDM"},{"code":"00003089331","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"APIXABAN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089431","type":"CDM"},{"code":"00003089431","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003256016","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00003256016","type":"NDC"}],"standard_charges":[{"gross_charge":305.25,"discounted_cash":106.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003257016","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00003257016","type":"NDC"}],"standard_charges":[{"gross_charge":610.76,"discounted_cash":213.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004029809","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"00004029809","type":"NDC"}],"standard_charges":[{"gross_charge":709.66,"discounted_cash":248.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004080085","type":"CDM"},{"code":"00004080085","type":"NDC"}],"standard_charges":[{"gross_charge":20.88,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004080285","type":"CDM"},{"code":"00004080285","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":6.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00004082205","type":"CDM"},{"code":"00004082205","type":"NDC"}],"standard_charges":[{"gross_charge":43.51,"discounted_cash":15.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005200002","type":"CDM"},{"code":"90677","type":"HCPCS"},{"code":"00005200002","type":"NDC"}],"standard_charges":[{"gross_charge":2384.7,"discounted_cash":834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005200010","type":"CDM"},{"code":"90677","type":"HCPCS"},{"code":"00005200010","type":"NDC"}],"standard_charges":[{"gross_charge":2384.71,"discounted_cash":834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IVERMECTIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006003220","type":"CDM"},{"code":"00006003220","type":"NDC"}],"standard_charges":[{"gross_charge":6.39,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006011201","type":"CDM"},{"code":"00006011201","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006011228","type":"CDM"},{"code":"00006011228","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 25 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022128","type":"CDM"},{"code":"00006022128","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM TAB 400 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022761","type":"CDM"},{"code":"00006022761","type":"NDC"}],"standard_charges":[{"gross_charge":47.75,"discounted_cash":16.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006027728","type":"CDM"},{"code":"00006027728","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEMBROLIZUMAB IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00006302604","type":"CDM"},{"code":"J9271","type":"HCPCS"},{"code":"00006302604","type":"NDC"}],"standard_charges":[{"gross_charge":29928.0,"discounted_cash":10474.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006351458","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"00006351458","type":"NDC"}],"standard_charges":[{"gross_charge":181.7,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006351659","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"00006351659","type":"NDC"}],"standard_charges":[{"gross_charge":341.48,"discounted_cash":119.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006384371","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"00006384371","type":"NDC"}],"standard_charges":[{"gross_charge":1331.33,"discounted_cash":465.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006468100","type":"CDM"},{"code":"90707","type":"HCPCS"},{"code":"00006468100","type":"NDC"}],"standard_charges":[{"gross_charge":1002.04,"discounted_cash":350.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006468101","type":"CDM"},{"code":"90707","type":"HCPCS"},{"code":"00006468101","type":"NDC"}],"standard_charges":[{"gross_charge":1002.04,"discounted_cash":350.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 5 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 5 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00006498100","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"00006498100","type":"NDC"}],"standard_charges":[{"gross_charge":225.84,"discounted_cash":79.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00006542312","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00006542312","type":"NDC"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00007323201","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"00007323201","type":"NDC"}],"standard_charges":[{"gross_charge":599.42,"discounted_cash":209.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARGATROBAN INJ 250 MG/2.5ML (CONCENTRATE FOR IV INFUSION)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00007440701","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"00007440701","type":"NDC"}],"standard_charges":[{"gross_charge":13690.2,"discounted_cash":4791.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008083602","type":"CDM"},{"code":"00008083602","type":"NDC"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008084181","type":"CDM"},{"code":"00008084181","type":"NDC"}],"standard_charges":[{"gross_charge":19.9,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092351","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092351","type":"NDC"}],"standard_charges":[{"gross_charge":97.83,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008499019","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"00008499019","type":"NDC"}],"standard_charges":[{"gross_charge":808.97,"discounted_cash":283.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001103","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001103","type":"NDC"}],"standard_charges":[{"gross_charge":244.6,"discounted_cash":85.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001104","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001104","type":"NDC"}],"standard_charges":[{"gross_charge":242.51,"discounted_cash":84.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003101","type":"CDM"},{"code":"00009003101","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003928","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003928","type":"NDC"}],"standard_charges":[{"gross_charge":99.18,"discounted_cash":34.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003930","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003930","type":"NDC"}],"standard_charges":[{"gross_charge":97.71,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004722","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004722","type":"NDC"}],"standard_charges":[{"gross_charge":102.8,"discounted_cash":35.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004725","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004725","type":"NDC"}],"standard_charges":[{"gross_charge":100.63,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL CYPIONATE IM IN OIL 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009027101","type":"CDM"},{"code":"J1000","type":"HCPCS"},{"code":"00009027101","type":"NDC"}],"standard_charges":[{"gross_charge":504.04,"discounted_cash":176.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GELATIN ABSORBABLE SPONGE SIZE 100","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009034201","type":"CDM"},{"code":"00009034201","type":"NDC"}],"standard_charges":[{"gross_charge":64.72,"discounted_cash":22.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARGININE HCL INJ 10%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009043601","type":"CDM"},{"code":"00009043601","type":"NDC"}],"standard_charges":[{"gross_charge":430.08,"discounted_cash":150.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009069801","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009069801","type":"NDC"}],"standard_charges":[{"gross_charge":451.13,"discounted_cash":157.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009075801","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009075801","type":"NDC"}],"standard_charges":[{"gross_charge":248.86,"discounted_cash":87.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009077520","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009077520","type":"NDC"}],"standard_charges":[{"gross_charge":94.49,"discounted_cash":33.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009082501","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009082501","type":"NDC"}],"standard_charges":[{"gross_charge":194.09,"discounted_cash":67.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009087021","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009087021","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009087026","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009087026","type":"NDC"}],"standard_charges":[{"gross_charge":95.52,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009090218","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009090218","type":"NDC"}],"standard_charges":[{"gross_charge":94.55,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRINOTECAN HCL INJ 40 MG/2ML (20 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009111101","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00009111101","type":"NDC"}],"standard_charges":[{"gross_charge":289.08,"discounted_cash":101.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009111102","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00009111102","type":"NDC"}],"standard_charges":[{"gross_charge":323.49,"discounted_cash":113.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00009307301","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009307301","type":"NDC"}],"standard_charges":[{"gross_charge":94.1,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPROSTADIL INJ 500 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009316901","type":"CDM"},{"code":"J0270","type":"HCPCS"},{"code":"00009316901","type":"NDC"}],"standard_charges":[{"gross_charge":1330.38,"discounted_cash":465.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPROSTADIL INJ 500 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009316906","type":"CDM"},{"code":"J0270","type":"HCPCS"},{"code":"00009316906","type":"NDC"}],"standard_charges":[{"gross_charge":1707.32,"discounted_cash":597.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00009347503","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009347503","type":"NDC"}],"standard_charges":[{"gross_charge":151.89,"discounted_cash":53.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUTILIDE FUMARATE INJ 1 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00009379401","type":"CDM"},{"code":"J1742","type":"HCPCS"},{"code":"00009379401","type":"NDC"}],"standard_charges":[{"gross_charge":904.28,"discounted_cash":316.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009513503","type":"CDM"},{"code":"00009513503","type":"NDC"}],"standard_charges":[{"gross_charge":155.21,"discounted_cash":54.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LINEZOLID IV SOLN 200 MG/100ML (2 MG/ML),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),LINEZOLID IN SODIUM CHLORIDE IV SOLN 600 MG/300ML-0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009514001","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00009514001","type":"NDC"}],"standard_charges":[{"gross_charge":615.96,"discounted_cash":215.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IDARUBICIN HCL IV INJ 5 MG/5ML (1 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00013257691","type":"CDM"},{"code":"J9211","type":"HCPCS"},{"code":"00013257691","type":"NDC"}],"standard_charges":[{"gross_charge":624.74,"discounted_cash":218.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IDARUBICIN HCL IV INJ 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00013258691","type":"CDM"},{"code":"J9211","type":"HCPCS"},{"code":"00013258691","type":"NDC"}],"standard_charges":[{"gross_charge":1044.37,"discounted_cash":365.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IDARUBICIN HCL IV INJ 20 MG/20ML (1 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00013259691","type":"CDM"},{"code":"J9211","type":"HCPCS"},{"code":"00013259691","type":"NDC"}],"standard_charges":[{"gross_charge":1910.91,"discounted_cash":668.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00013872789","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"00013872789","type":"NDC"}],"standard_charges":[{"gross_charge":4494.67,"discounted_cash":1573.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOTHALAMATE MEGLUMINE INJ 17.2%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00019086250","type":"CDM"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086250","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONABOTULINUMTOXINA FOR INJ 100 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023114501","type":"CDM"},{"code":"J0585","type":"HCPCS"},{"code":"00023114501","type":"NDC"}],"standard_charges":[{"gross_charge":7235.2,"discounted_cash":2532.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00023608210","type":"CDM"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210","type":"NDC"}],"standard_charges":[{"gross_charge":101.79,"discounted_cash":35.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DRONEDARONE HCL TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024414210","type":"CDM"},{"code":"00024414210","type":"NDC"}],"standard_charges":[{"gross_charge":14.95,"discounted_cash":5.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DRONEDARONE HCL TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024414260","type":"CDM"},{"code":"00024414260","type":"NDC"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":6.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RASBURICASE FOR IV SOLN 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024515010","type":"CDM"},{"code":"J2783","type":"HCPCS"},{"code":"00024515010","type":"NDC"}],"standard_charges":[{"gross_charge":11447.68,"discounted_cash":4006.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RASBURICASE FOR IV SOLN 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024515175","type":"CDM"},{"code":"J2783","type":"HCPCS"},{"code":"00024515175","type":"NDC"}],"standard_charges":[{"gross_charge":27536.45,"discounted_cash":9637.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00024592605","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00024592605","type":"NDC"}],"standard_charges":[{"gross_charge":18.47,"discounted_cash":6.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00024592605","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00024592605","type":"NDC"}],"standard_charges":[{"gross_charge":18.47,"discounted_cash":6.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025145134","type":"CDM"},{"code":"00025145134","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025146134","type":"CDM"},{"code":"00025146134","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025146160","type":"CDM"},{"code":"00025146160","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 6000-19000-30000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032004670","type":"CDM"},{"code":"00032004670","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 12000-38000-60000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032004770","type":"CDM"},{"code":"00032004770","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 3000-9500-15000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032120370","type":"CDM"},{"code":"00032120370","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 6000-19000-30000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032120601","type":"CDM"},{"code":"00032120601","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 6000-19000-30000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032120607","type":"CDM"},{"code":"00032120607","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 12000-38000-60000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032121201","type":"CDM"},{"code":"00032121201","type":"NDC"}],"standard_charges":[{"gross_charge":5.71,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 12000-38000-60000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032121207","type":"CDM"},{"code":"00032121207","type":"NDC"}],"standard_charges":[{"gross_charge":5.44,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032122401","type":"CDM"},{"code":"00032122401","type":"NDC"}],"standard_charges":[{"gross_charge":11.32,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032263601","type":"CDM"},{"code":"00032263601","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTROGENS, CONJUGATED FOR INJ 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046074905","type":"CDM"},{"code":"J1410","type":"HCPCS"},{"code":"00046074905","type":"NDC"}],"standard_charges":[{"gross_charge":3870.27,"discounted_cash":1354.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTROGENS, CONJUGATED VAGINAL CREAM 0.625 MG/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00046087221","type":"CDM"},{"code":"00046087221","type":"NDC"}],"standard_charges":[{"gross_charge":633.82,"discounted_cash":221.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110081","type":"CDM"},{"code":"00046110081","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.45 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110181","type":"CDM"},{"code":"00046110181","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110281","type":"CDM"},{"code":"00046110281","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001481","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001481","type":"NDC"}],"standard_charges":[{"gross_charge":99.01,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052083","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052083","type":"NDC"}],"standard_charges":[{"gross_charge":130.58,"discounted_cash":45.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 20000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049053028","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049053028","type":"NDC"}],"standard_charges":[{"gross_charge":522.03,"discounted_cash":182.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049276066","type":"CDM"},{"code":"00049276066","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049319028","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"00049319028","type":"NDC"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE FOR SUSP 10 MG/ML","drug_information":{"unit":35.0,"type":"ML"},"code_information":[{"code":"Rx00049344019","type":"CDM"},{"code":"00049344019","type":"NDC"}],"standard_charges":[{"gross_charge":23.36,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049396041","type":"CDM"},{"code":"00049396041","type":"NDC"}],"standard_charges":[{"gross_charge":18.82,"discounted_cash":6.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049396060","type":"CDM"},{"code":"00049396060","type":"NDC"}],"standard_charges":[{"gross_charge":26.86,"discounted_cash":9.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054000725","type":"CDM"},{"code":"00054000725","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001020","type":"CDM"},{"code":"00054001020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001021","type":"CDM"},{"code":"00054001021","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001720","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001725","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001725","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001820","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001829","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001829","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001920","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001925","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001925","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 450 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054002025","type":"CDM"},{"code":"00054002025","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054002125","type":"CDM"},{"code":"00054002125","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN ORAL SOLN 0.05 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00054005746","type":"CDM"},{"code":"00054005746","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BALSALAZIDE DISODIUM CAP 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054007928","type":"CDM"},{"code":"00054007928","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EXEMESTANE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054008013","type":"CDM"},{"code":"00054008013","type":"NDC"}],"standard_charges":[{"gross_charge":14.93,"discounted_cash":5.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054008826","type":"CDM"},{"code":"00054008826","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054011825","type":"CDM"},{"code":"00054011825","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054016329","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00054016329","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054017613","type":"CDM"},{"code":"00054017613","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054017713","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"00054017713","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL TAB 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054018913","type":"CDM"},{"code":"00054018913","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054022463","type":"CDM"},{"code":"00054022463","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054022925","type":"CDM"},{"code":"00054022925","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023524","type":"CDM"},{"code":"00054023524","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023525","type":"CDM"},{"code":"00054023525","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023625","type":"CDM"},{"code":"00054023625","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00054023763","type":"CDM"},{"code":"00054023763","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054040450","type":"CDM"},{"code":"00054040450","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054252625","type":"CDM"},{"code":"00054252625","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITRIOL ORAL SOLN 1 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054312041","type":"CDM"},{"code":"00054312041","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SOLN 0.5 MG/5ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00054317763","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054317763","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM CONC 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00054318544","type":"CDM"},{"code":"00054318544","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM ORAL SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00054318863","type":"CDM"},{"code":"00054318863","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00054329446","type":"CDM"},{"code":"00054329446","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE ORAL SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00054329450","type":"CDM"},{"code":"00054329450","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054350049","type":"CDM"},{"code":"00054350049","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00054350547","type":"CDM"},{"code":"00054350547","type":"NDC"}],"standard_charges":[{"gross_charge":55.8,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM ORAL SOLUTION 8 MEQ/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054352763","type":"CDM"},{"code":"00054352763","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054354258","type":"CDM"},{"code":"00054354258","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054355563","type":"CDM"},{"code":"00054355563","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00054356699","type":"CDM"},{"code":"00054356699","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL ORAL SOLN 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00054372763","type":"CDM"},{"code":"00054372763","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054408425","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"00054408425","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054418125","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054418125","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054418325","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054418325","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054429931","type":"CDM"},{"code":"00054429931","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MERCAPTOPURINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054458111","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00054458111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054474125","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054474125","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAZOLAM TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054485851","type":"CDM"},{"code":"00054485851","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054485929","type":"CDM"},{"code":"00054485929","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054814622","type":"CDM"},{"code":"00054814622","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817425","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817425","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817525","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817525","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817625","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817625","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054852625","type":"CDM"},{"code":"00054852625","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054852725","type":"CDM"},{"code":"00054852725","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054852825","type":"CDM"},{"code":"00054852825","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054872425","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054872425","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054873925","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054873925","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAZOLAM TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054885825","type":"CDM"},{"code":"00054885825","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054885925","type":"CDM"},{"code":"00054885925","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017201","type":"CDM"},{"code":"00056017201","type":"NDC"}],"standard_charges":[{"gross_charge":3.2,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017275","type":"CDM"},{"code":"00056017275","type":"NDC"}],"standard_charges":[{"gross_charge":3.2,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017675","type":"CDM"},{"code":"00056017675","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EFAVIRENZ TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056051030","type":"CDM"},{"code":"00056051030","type":"NDC"}],"standard_charges":[{"gross_charge":45.3,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBACHOL INTRAOCULAR INJ 0.01%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00065002315","type":"CDM"},{"code":"00065002315","type":"NDC"}],"standard_charges":[{"gross_charge":20.93,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPENTOLATE W/ PHENYLEPHRINE OPHTH SOLN 0.2-1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00065035902","type":"CDM"},{"code":"00065035902","type":"NDC"}],"standard_charges":[{"gross_charge":48.57,"discounted_cash":17.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPENTOLATE W/ PHENYLEPHRINE OPHTH SOLN 0.2-1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065035905","type":"CDM"},{"code":"00065035905","type":"NDC"}],"standard_charges":[{"gross_charge":85.38,"discounted_cash":29.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00065039515","type":"CDM"},{"code":"00065039515","type":"NDC"}],"standard_charges":[{"gross_charge":132.88,"discounted_cash":46.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POVIDONE-IODINE OPHTH SOLN 5%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00065041130","type":"CDM"},{"code":"00065041130","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065064435","type":"CDM"},{"code":"00065064435","type":"NDC"}],"standard_charges":[{"gross_charge":297.07,"discounted_cash":103.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATAMYCIN OPHTH SUSP 5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00065064515","type":"CDM"},{"code":"00065064515","type":"NDC"}],"standard_charges":[{"gross_charge":496.46,"discounted_cash":173.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065064705","type":"CDM"},{"code":"00065064705","type":"NDC"}],"standard_charges":[{"gross_charge":229.68,"discounted_cash":80.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH OINT 0.3-0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065064835","type":"CDM"},{"code":"00065064835","type":"NDC"}],"standard_charges":[{"gross_charge":314.47,"discounted_cash":110.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 1% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00065066010","type":"CDM"},{"code":"00065066010","type":"NDC"}],"standard_charges":[{"gross_charge":38.24,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETRACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00065074114","type":"CDM"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":6.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00065079515","type":"CDM"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00065079550","type":"CDM"},{"code":"00065079550","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":6.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00065080094","type":"CDM"},{"code":"00065080094","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN FOR INJ 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00068059701","type":"CDM"},{"code":"J2804","type":"HCPCS"},{"code":"00068059701","type":"NDC"}],"standard_charges":[{"gross_charge":1833.66,"discounted_cash":641.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069005802","type":"CDM"},{"code":"J1643","type":"HCPCS"},{"code":"00069005802","type":"NDC"}],"standard_charges":[{"gross_charge":93.82,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00069007401","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"00069007401","type":"NDC"}],"standard_charges":[{"gross_charge":1067.65,"discounted_cash":373.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069008801","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"00069008801","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"},{"gross_charge":95.14,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYTARABINE INJ PF 20 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00069015401","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"00069015401","type":"NDC"}],"standard_charges":[{"gross_charge":319.87,"discounted_cash":111.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXORUBICIN HCL FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069017001","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069017001","type":"NDC"}],"standard_charges":[{"gross_charge":286.16,"discounted_cash":100.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00069024801","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069024801","type":"NDC"}],"standard_charges":[{"gross_charge":101.55,"discounted_cash":35.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RITUXIMAB-PVVR IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00069024901","type":"CDM"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901","type":"NDC"}],"standard_charges":[{"gross_charge":20170.65,"discounted_cash":7059.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00069029101","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029101","type":"NDC"}],"standard_charges":[{"gross_charge":877.96,"discounted_cash":307.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx00069029201","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029201","type":"NDC"}],"standard_charges":[{"gross_charge":1404.82,"discounted_cash":491.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BEVACIZUMAB-BVZR IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00069031501","type":"CDM"},{"code":"Q5118","type":"HCPCS"},{"code":"00069031501","type":"NDC"}],"standard_charges":[{"gross_charge":4559.78,"discounted_cash":1595.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BEVACIZUMAB-BVZR IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx00069034201","type":"CDM"},{"code":"Q5118","type":"HCPCS"},{"code":"00069034201","type":"NDC"}],"standard_charges":[{"gross_charge":17931.2,"discounted_cash":6275.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130501","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130501","type":"NDC"}],"standard_charges":[{"gross_charge":192.94,"discounted_cash":67.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130510","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130510","type":"NDC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":67.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 3000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130601","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130601","type":"NDC"}],"standard_charges":[{"gross_charge":292.67,"discounted_cash":102.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 3000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130610","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130610","type":"NDC"}],"standard_charges":[{"gross_charge":289.52,"discounted_cash":101.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 4000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130701","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130701","type":"NDC"}],"standard_charges":[{"gross_charge":385.89,"discounted_cash":135.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 4000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130710","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130710","type":"NDC"}],"standard_charges":[{"gross_charge":386.01,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130801","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130801","type":"NDC"}],"standard_charges":[{"gross_charge":964.74,"discounted_cash":337.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130810","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130810","type":"NDC"}],"standard_charges":[{"gross_charge":965.07,"discounted_cash":337.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069154041","type":"CDM"},{"code":"00069154041","type":"NDC"}],"standard_charges":[{"gross_charge":8.92,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-PFIZER IM SUSP PREF SYR 30 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00069243201","type":"CDM"},{"code":"91320","type":"HCPCS"},{"code":"00069243201","type":"NDC"}],"standard_charges":[{"gross_charge":241.66,"discounted_cash":84.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COVID-19 MRNA VAC TRIS-PFIZER IM SUSP PREF SYR 30 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00069243210","type":"CDM"},{"code":"91320","type":"HCPCS"},{"code":"00069243210","type":"NDC"}],"standard_charges":[{"gross_charge":241.66,"discounted_cash":84.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00069303120","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069303120","type":"NDC"}],"standard_charges":[{"gross_charge":289.34,"discounted_cash":101.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600102","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600102","type":"NDC"}],"standard_charges":[{"gross_charge":95.8,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071080324","type":"CDM"},{"code":"00071080324","type":"NDC"}],"standard_charges":[{"gross_charge":4.06,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101341","type":"CDM"},{"code":"00071101341","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101368","type":"CDM"},{"code":"00071101368","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074310832","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00074310832","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RITONAVIR TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074333330","type":"CDM"},{"code":"00074333330","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR INJ KIT 3.75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074364103","type":"CDM"},{"code":"J1950","type":"HCPCS"},{"code":"00074364103","type":"NDC"}],"standard_charges":[{"gross_charge":13200.13,"discounted_cash":4620.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR INJ KIT 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074364203","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"00074364203","type":"NDC"}],"standard_charges":[{"gross_charge":1774.95,"discounted_cash":621.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074382611","type":"CDM"},{"code":"00074382611","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PARICALCITOL IV SOLN 2 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074463701","type":"CDM"},{"code":"J2501","type":"HCPCS"},{"code":"00074463701","type":"NDC"}],"standard_charges":[{"gross_charge":96.91,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074518211","type":"CDM"},{"code":"00074518211","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOPINAVIR-RITONAVIR TAB 200-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074679922","type":"CDM"},{"code":"00074679922","type":"NDC"}],"standard_charges":[{"gross_charge":11.73,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED ORAL SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074726950","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00074726950","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00075062040","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"gross_charge":102.34,"discounted_cash":35.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00075062160","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062160","type":"NDC"}],"standard_charges":[{"gross_charge":127.52,"discounted_cash":44.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00075062280","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062280","type":"NDC"}],"standard_charges":[{"gross_charge":178.54,"discounted_cash":62.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00075062300","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"gross_charge":229.54,"discounted_cash":80.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00075062430","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062430","type":"NDC"}],"standard_charges":[{"gross_charge":100.07,"discounted_cash":35.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00075291201","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075291201","type":"NDC"}],"standard_charges":[{"gross_charge":280.64,"discounted_cash":98.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00075291501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075291501","type":"NDC"}],"standard_charges":[{"gross_charge":331.67,"discounted_cash":116.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RILUZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00075770060","type":"CDM"},{"code":"00075770060","type":"NDC"}],"standard_charges":[{"gross_charge":26.49,"discounted_cash":9.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00075800301","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00075800301","type":"NDC"}],"standard_charges":[{"gross_charge":5626.43,"discounted_cash":1969.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024015","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00078024015","type":"NDC"}],"standard_charges":[{"gross_charge":6.29,"discounted_cash":2.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024061","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00078024061","type":"NDC"}],"standard_charges":[{"gross_charge":3.19,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024115","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00078024115","type":"NDC"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024161","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00078024161","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024615","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00078024615","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024661","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00078024661","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078032705","type":"CDM"},{"code":"00078032705","type":"NDC"}],"standard_charges":[{"gross_charge":7.83,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.0375 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078034362","type":"CDM"},{"code":"00078034362","type":"NDC"}],"standard_charges":[{"gross_charge":19.34,"discounted_cash":6.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078034462","type":"CDM"},{"code":"00078034462","type":"NDC"}],"standard_charges":[{"gross_charge":21.27,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078034645","type":"CDM"},{"code":"00078034645","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078034662","type":"CDM"},{"code":"00078034662","type":"NDC"}],"standard_charges":[{"gross_charge":23.2,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.025 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078036542","type":"CDM"},{"code":"00078036542","type":"NDC"}],"standard_charges":[{"gross_charge":26.43,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.025 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078036562","type":"CDM"},{"code":"00078036562","type":"NDC"}],"standard_charges":[{"gross_charge":26.43,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078038566","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00078038566","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 360 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078038666","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00078038666","type":"NDC"}],"standard_charges":[{"gross_charge":20.51,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078042315","type":"CDM"},{"code":"00078042315","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMETHYLPHENIDATE HCL CAP ER 24 HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078043005","type":"CDM"},{"code":"00078043005","type":"NDC"}],"standard_charges":[{"gross_charge":6.76,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMETHYLPHENIDATE HCL CAP ER 24 HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078043105","type":"CDM"},{"code":"00078043105","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMETHYLPHENIDATE HCL CAP ER 24 HR 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078043205","type":"CDM"},{"code":"00078043205","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMETHYLPHENIDATE HCL CAP ER 24 HR 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078049305","type":"CDM"},{"code":"00078049305","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078065920","type":"CDM"},{"code":"00078065920","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078065935","type":"CDM"},{"code":"00078065935","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078065961","type":"CDM"},{"code":"00078065961","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078065967","type":"CDM"},{"code":"00078065967","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 97-103 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069620","type":"CDM"},{"code":"00078069620","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 97-103 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069635","type":"CDM"},{"code":"00078069635","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 97-103 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069661","type":"CDM"},{"code":"00078069661","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDOSTAURIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069802","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078069802","type":"NDC"}],"standard_charges":[{"gross_charge":187.95,"discounted_cash":65.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDOSTAURIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069851","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00078069851","type":"NDC"}],"standard_charges":[{"gross_charge":212.58,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 49-51 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078077720","type":"CDM"},{"code":"00078077720","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 49-51 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078077735","type":"CDM"},{"code":"00078077735","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 49-51 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078077761","type":"CDM"},{"code":"00078077761","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00078081301","type":"CDM"},{"code":"00078081301","type":"NDC"}],"standard_charges":[{"gross_charge":385.09,"discounted_cash":134.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078081881","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00078081881","type":"NDC"}],"standard_charges":[{"gross_charge":46932.03,"discounted_cash":16426.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078082581","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00078082581","type":"NDC"}],"standard_charges":[{"gross_charge":70277.08,"discounted_cash":24596.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INCLISIRAN SODIUM SUBCUTANEOUS SOLN PREF SYR 284 MG/1.5ML","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00078100060","type":"CDM"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":37782.64,"discounted_cash":13223.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.8 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085081930","type":"CDM"},{"code":"00085081930","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":6.7,"type":"GM"},"code_information":[{"code":"Rx00085113201","type":"CDM"},{"code":"00085113201","type":"NDC"}],"standard_charges":[{"gross_charge":111.37,"discounted_cash":38.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085134106","type":"CDM"},{"code":"00085134106","type":"NDC"}],"standard_charges":[{"gross_charge":102.76,"discounted_cash":35.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085134107","type":"CDM"},{"code":"00085134107","type":"NDC"}],"standard_charges":[{"gross_charge":266.25,"discounted_cash":93.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 110 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085146102","type":"CDM"},{"code":"00085146102","type":"NDC"}],"standard_charges":[{"gross_charge":246.57,"discounted_cash":86.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MOXIFLOXACIN HCL 400 MG/250ML IN SODIUM CHLORIDE 0.8% INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00085173701","type":"CDM"},{"code":"J2280","type":"HCPCS"},{"code":"00085173701","type":"NDC"}],"standard_charges":[{"gross_charge":553.9,"discounted_cash":193.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.3 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085331530","type":"CDM"},{"code":"00085331530","type":"NDC"}],"standard_charges":[{"gross_charge":7.78,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.3 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085331535","type":"CDM"},{"code":"00085331535","type":"NDC"}],"standard_charges":[{"gross_charge":7.76,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRBESARTAN TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00087277235","type":"CDM"},{"code":"00087277235","type":"NDC"}],"standard_charges":[{"gross_charge":4.09,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005001","type":"CDM"},{"code":"00093005001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005101","type":"CDM"},{"code":"00093005101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005301","type":"CDM"},{"code":"00093005301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005401","type":"CDM"},{"code":"00093005401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093007301","type":"CDM"},{"code":"00093007301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031401","type":"CDM"},{"code":"00093031401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031801","type":"CDM"},{"code":"00093031801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031805","type":"CDM"},{"code":"00093031805","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031901","type":"CDM"},{"code":"00093031901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093032001","type":"CDM"},{"code":"00093032001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093035001","type":"CDM"},{"code":"00093035001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093075201","type":"CDM"},{"code":"00093075201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093075210","type":"CDM"},{"code":"00093075210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093078710","type":"CDM"},{"code":"00093078710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081001","type":"CDM"},{"code":"00093081001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081101","type":"CDM"},{"code":"00093081101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093083201","type":"CDM"},{"code":"00093083201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093090001","type":"CDM"},{"code":"00093090001","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEFAZODONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093102506","type":"CDM"},{"code":"00093102506","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093106101","type":"CDM"},{"code":"00093106101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN SULFATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093117701","type":"CDM"},{"code":"00093117701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093171201","type":"CDM"},{"code":"00093171201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093172101","type":"CDM"},{"code":"00093172101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093217901","type":"CDM"},{"code":"00093217901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220401","type":"CDM"},{"code":"00093220401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220405","type":"CDM"},{"code":"00093220405","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093221001","type":"CDM"},{"code":"00093221001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093227434","type":"CDM"},{"code":"00093227434","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093227534","type":"CDM"},{"code":"00093227534","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093292919","type":"CDM"},{"code":"00093292919","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093310701","type":"CDM"},{"code":"00093310701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093310719","type":"CDM"},{"code":"00093310719","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312501","type":"CDM"},{"code":"00093312501","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312901","type":"CDM"},{"code":"00093312901","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093316501","type":"CDM"},{"code":"00093316501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093365522","type":"CDM"},{"code":"00093365522","type":"NDC"}],"standard_charges":[{"gross_charge":27.32,"discounted_cash":9.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414504","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414504","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414556","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414556","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414604","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414604","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414656","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414656","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414804","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414804","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093423201","type":"CDM"},{"code":"00093423201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALENDRONATE SODIUM TAB 35 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093517219","type":"CDM"},{"code":"00093517219","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZALEPLON CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093526901","type":"CDM"},{"code":"00093526901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMETHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093527601","type":"CDM"},{"code":"00093527601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE FOR SUSP 10 MG/ML","drug_information":{"unit":35.0,"type":"ML"},"code_information":[{"code":"Rx00093541495","type":"CDM"},{"code":"00093541495","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CABERGOLINE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093542088","type":"CDM"},{"code":"J8515","type":"HCPCS"},{"code":"00093542088","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE CAP DR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093590786","type":"CDM"},{"code":"00093590786","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093598619","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00093598619","type":"NDC"}],"standard_charges":[{"gross_charge":1557.19,"discounted_cash":545.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681545","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681545","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681573","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681573","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681645","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681645","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 1 MG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00093681773","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681773","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEFAZODONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093711306","type":"CDM"},{"code":"00093711306","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093720198","type":"CDM"},{"code":"00093720198","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093729056","type":"CDM"},{"code":"00093729056","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093736598","type":"CDM"},{"code":"00093736598","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093738498","type":"CDM"},{"code":"00093738498","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093738556","type":"CDM"},{"code":"00093738556","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRBESARTAN TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093746498","type":"CDM"},{"code":"00093746498","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIMETIDINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093819201","type":"CDM"},{"code":"00093819201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIMETIDINE TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093820401","type":"CDM"},{"code":"00093820401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEXILETINE HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093873901","type":"CDM"},{"code":"00093873901","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEXILETINE HCL CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093874001","type":"CDM"},{"code":"00093874001","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093894001","type":"CDM"},{"code":"00093894001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093902065","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093902065","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093970201","type":"CDM"},{"code":"00093970201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx000DELETEDx","type":"CDM"},{"code":"DELETEDx","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115133101","type":"CDM"},{"code":"00115133101","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115133301","type":"CDM"},{"code":"00115133301","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00115146860","type":"CDM"},{"code":"00115146860","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00115168976","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00115168976","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115169449","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00115169449","type":"NDC"}],"standard_charges":[{"gross_charge":1253.78,"discounted_cash":438.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115169701","type":"CDM"},{"code":"00115169701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIMANTADINE HYDROCHLORIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115191101","type":"CDM"},{"code":"00115191101","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115441101","type":"CDM"},{"code":"00115441101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115442201","type":"CDM"},{"code":"00115442201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115592201","type":"CDM"},{"code":"00115592201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115681110","type":"CDM"},{"code":"00115681110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115703301","type":"CDM"},{"code":"00115703301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115703302","type":"CDM"},{"code":"00115703302","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116200116","type":"CDM"},{"code":"00116200116","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116400532","type":"CDM"},{"code":"00116400532","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00121050405","type":"CDM"},{"code":"00121050405","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00121050412","type":"CDM"},{"code":"00121050412","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121067585","type":"CDM"},{"code":"00121067585","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CITRATE & CITRIC ACID SOLN 1100-334 MG/5ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121067616","type":"CDM"},{"code":"00121067616","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121075908","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121075908","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00121086720","type":"CDM"},{"code":"00121086720","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086800","type":"CDM"},{"code":"00121086800","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121092716","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"00121092716","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121094500","type":"CDM"},{"code":"00121094500","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00121097251","type":"CDM"},{"code":"00121097251","type":"NDC"}],"standard_charges":[{"gross_charge":21.52,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121104516","type":"CDM"},{"code":"00121104516","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115400","type":"CDM"},{"code":"00121115400","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115430","type":"CDM"},{"code":"00121115430","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121157610","type":"CDM"},{"code":"00121157610","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121177505","type":"CDM"},{"code":"00121177505","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121177540","type":"CDM"},{"code":"00121177540","type":"NDC"}],"standard_charges":[{"gross_charge":4.53,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121467500","type":"CDM"},{"code":"00121467500","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121467505","type":"CDM"},{"code":"00121467505","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121477205","type":"CDM"},{"code":"00121477205","type":"NDC"}],"standard_charges":[{"gross_charge":5.61,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121477240","type":"CDM"},{"code":"00121477240","type":"NDC"}],"standard_charges":[{"gross_charge":14.13,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121477610","type":"CDM"},{"code":"00121477610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121479905","type":"CDM"},{"code":"00121479905","type":"NDC"}],"standard_charges":[{"gross_charge":4.21,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121479950","type":"CDM"},{"code":"00121479950","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121481105","type":"CDM"},{"code":"00121481105","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121482705","type":"CDM"},{"code":"00121482705","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121482750","type":"CDM"},{"code":"00121482750","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495015","type":"CDM"},{"code":"00121495015","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495040","type":"CDM"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00131181067","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"00131181067","type":"NDC"}],"standard_charges":[{"gross_charge":304.6,"discounted_cash":106.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143117201","type":"CDM"},{"code":"00143117201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPYLTHIOURACIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143148001","type":"CDM"},{"code":"00143148001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143176901","type":"CDM"},{"code":"00143176901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143177101","type":"CDM"},{"code":"00143177101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143177201","type":"CDM"},{"code":"00143177201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143211250","type":"CDM"},{"code":"00143211250","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143314150","type":"CDM"},{"code":"00143314150","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXORUBICIN HCL FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143909301","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143909301","type":"NDC"}],"standard_charges":[{"gross_charge":2462.48,"discounted_cash":861.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143913901","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143913901","type":"NDC"}],"standard_charges":[{"gross_charge":97.15,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143914001","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143914001","type":"NDC"}],"standard_charges":[{"gross_charge":98.75,"discounted_cash":34.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143914025","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143914025","type":"NDC"}],"standard_charges":[{"gross_charge":97.96,"discounted_cash":34.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915201","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915201","type":"NDC"}],"standard_charges":[{"gross_charge":184.92,"discounted_cash":64.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915210","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915210","type":"NDC"}],"standard_charges":[{"gross_charge":102.87,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143916201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143916201","type":"NDC"}],"standard_charges":[{"gross_charge":95.43,"discounted_cash":33.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143920401","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00143920401","type":"NDC"}],"standard_charges":[{"gross_charge":380.21,"discounted_cash":133.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143920910","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"00143920910","type":"NDC"}],"standard_charges":[{"gross_charge":97.56,"discounted_cash":34.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143925001","type":"CDM"},{"code":"00143925001","type":"NDC"}],"standard_charges":[{"gross_charge":94.08,"discounted_cash":32.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143925010","type":"CDM"},{"code":"00143925010","type":"NDC"}],"standard_charges":[{"gross_charge":93.81,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143929701","type":"CDM"},{"code":"00143929701","type":"NDC"}],"standard_charges":[{"gross_charge":564.81,"discounted_cash":197.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00143931801","type":"CDM"},{"code":"00143931801","type":"NDC"}],"standard_charges":[{"gross_charge":98.95,"discounted_cash":34.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00143931810","type":"CDM"},{"code":"00143931810","type":"NDC"}],"standard_charges":[{"gross_charge":95.08,"discounted_cash":33.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143931901","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"00143931901","type":"NDC"}],"standard_charges":[{"gross_charge":93.84,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143939110","type":"CDM"},{"code":"00143939110","type":"NDC"}],"standard_charges":[{"gross_charge":392.5,"discounted_cash":137.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143939810","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"00143939810","type":"NDC"}],"standard_charges":[{"gross_charge":164.3,"discounted_cash":57.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143950301","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"00143950301","type":"NDC"}],"standard_charges":[{"gross_charge":251.55,"discounted_cash":88.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143950501","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"00143950501","type":"NDC"}],"standard_charges":[{"gross_charge":425.53,"discounted_cash":148.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143950610","type":"CDM"},{"code":"00143950610","type":"NDC"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":32.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143950810","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950810","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143951910","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00143951910","type":"NDC"}],"standard_charges":[{"gross_charge":263.07,"discounted_cash":92.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143952501","type":"CDM"},{"code":"00143952501","type":"NDC"}],"standard_charges":[{"gross_charge":308.56,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143956401","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"00143956401","type":"NDC"}],"standard_charges":[{"gross_charge":4780.04,"discounted_cash":1673.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143956410","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"00143956410","type":"NDC"}],"standard_charges":[{"gross_charge":4780.04,"discounted_cash":1673.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143957001","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143957001","type":"NDC"}],"standard_charges":[{"gross_charge":100.42,"discounted_cash":35.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143957010","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143957010","type":"NDC"}],"standard_charges":[{"gross_charge":101.06,"discounted_cash":35.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959401","type":"CDM"},{"code":"00143959401","type":"NDC"}],"standard_charges":[{"gross_charge":93.42,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143962201","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00143962201","type":"NDC"}],"standard_charges":[{"gross_charge":93.87,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143967325","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00143967325","type":"NDC"}],"standard_charges":[{"gross_charge":94.05,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968201","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968201","type":"NDC"}],"standard_charges":[{"gross_charge":96.87,"discounted_cash":33.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968225","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968225","type":"NDC"}],"standard_charges":[{"gross_charge":93.54,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143968410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968410","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143968910","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143968910","type":"NDC"}],"standard_charges":[{"gross_charge":102.51,"discounted_cash":35.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143970101","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00143970101","type":"NDC"}],"standard_charges":[{"gross_charge":253.09,"discounted_cash":88.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143971901","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971901","type":"NDC"}],"standard_charges":[{"gross_charge":102.55,"discounted_cash":35.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"},{"gross_charge":249.8,"discounted_cash":87.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143971910","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971910","type":"NDC"}],"standard_charges":[{"gross_charge":244.8,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143972024","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"gross_charge":246.05,"discounted_cash":86.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143972124","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972124","type":"NDC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143972224","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972224","type":"NDC"}],"standard_charges":[{"gross_charge":245.9,"discounted_cash":86.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143974610","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610","type":"NDC"}],"standard_charges":[{"gross_charge":94.4,"discounted_cash":33.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143975425","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143975425","type":"NDC"}],"standard_charges":[{"gross_charge":94.69,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978301","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978301","type":"NDC"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978310","type":"NDC"}],"standard_charges":[{"gross_charge":94.47,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978410","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143978510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978510","type":"NDC"}],"standard_charges":[{"gross_charge":95.4,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978601","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978601","type":"NDC"}],"standard_charges":[{"gross_charge":97.08,"discounted_cash":33.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978610","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978610","type":"NDC"}],"standard_charges":[{"gross_charge":97.08,"discounted_cash":33.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978701","type":"NDC"}],"standard_charges":[{"gross_charge":96.84,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978710","type":"NDC"}],"standard_charges":[{"gross_charge":97.54,"discounted_cash":34.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143985324","type":"CDM"},{"code":"00143985324","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985601","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985601","type":"NDC"}],"standard_charges":[{"gross_charge":94.71,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985625","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985625","type":"NDC"}],"standard_charges":[{"gross_charge":94.71,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985701","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985701","type":"NDC"}],"standard_charges":[{"gross_charge":95.51,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985725","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985725","type":"NDC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143987201","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"00143987201","type":"NDC"}],"standard_charges":[{"gross_charge":100.64,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987510","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987510","type":"NDC"}],"standard_charges":[{"gross_charge":95.11,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987525","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987525","type":"NDC"}],"standard_charges":[{"gross_charge":95.01,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987801","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987801","type":"NDC"}],"standard_charges":[{"gross_charge":101.96,"discounted_cash":35.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987825","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987825","type":"NDC"}],"standard_charges":[{"gross_charge":95.58,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992490","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143992490","type":"NDC"}],"standard_charges":[{"gross_charge":93.8,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992801","type":"CDM"},{"code":"00143992801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143997722","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143997722","type":"NDC"}],"standard_charges":[{"gross_charge":96.9,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR IV SOLN 1.5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143997790","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143997790","type":"NDC"}],"standard_charges":[{"gross_charge":96.03,"discounted_cash":33.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME SODIUM FOR INJ 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143997990","type":"CDM"},{"code":"J0697","type":"HCPCS"},{"code":"00143997990","type":"NDC"}],"standard_charges":[{"gross_charge":94.99,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00143998201","type":"CDM"},{"code":"00143998201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000615","type":"CDM"},{"code":"00168000615","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":80.0,"type":"GM"},"code_information":[{"code":"Rx00168000680","type":"CDM"},{"code":"00168000680","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000715","type":"CDM"},{"code":"00168000715","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":6.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168008031","type":"CDM"},{"code":"00168008031","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168008115","type":"CDM"},{"code":"00168008115","type":"NDC"}],"standard_charges":[{"gross_charge":93.08,"discounted_cash":32.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOCONAZOLE CREAM 2%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168009915","type":"CDM"},{"code":"00168009915","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE OINT 2.5%","drug_information":{"unit":28.35,"type":"GM"},"code_information":[{"code":"Rx00168014630","type":"CDM"},{"code":"00168014630","type":"NDC"}],"standard_charges":[{"gross_charge":5.27,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE GEL 1% (TWICE-DAILY)","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00168020230","type":"CDM"},{"code":"00168020230","type":"NDC"}],"standard_charges":[{"gross_charge":65.02,"discounted_cash":22.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168025815","type":"CDM"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00168025846","type":"CDM"},{"code":"00168025846","type":"NDC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE VAGINAL CREAM 2%","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"Rx00168027740","type":"CDM"},{"code":"00168027740","type":"NDC"}],"standard_charges":[{"gross_charge":103.68,"discounted_cash":36.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168035755","type":"CDM"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169183711","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169183711","type":"NDC"}],"standard_charges":[{"gross_charge":363.12,"discounted_cash":127.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN ASPART PROT & ASPART (HUMAN) INJ 100 UNIT/ML (70-30)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169368512","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169368512","type":"NDC"}],"standard_charges":[{"gross_charge":352.1,"discounted_cash":123.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 1 MG (1000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169701001","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169701001","type":"NDC"}],"standard_charges":[{"gross_charge":24640.0,"discounted_cash":8624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 2 MG (2000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169702001","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169702001","type":"NDC"}],"standard_charges":[{"gross_charge":49280.0,"discounted_cash":17248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 1 MG (1000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169720101","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169720101","type":"NDC"}],"standard_charges":[{"gross_charge":26987.29,"discounted_cash":9445.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 5 MG (5000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169720501","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169720501","type":"NDC"}],"standard_charges":[{"gross_charge":134936.25,"discounted_cash":47227.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172375960","type":"CDM"},{"code":"00172375960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172392760","type":"CDM"},{"code":"00172392760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172409660","type":"CDM"},{"code":"00172409660","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172409760","type":"CDM"},{"code":"00172409760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANAGRELIDE HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172524060","type":"CDM"},{"code":"00172524060","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541000","type":"CDM"},{"code":"00172541000","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541046","type":"CDM"},{"code":"00172541046","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541146","type":"CDM"},{"code":"00172541146","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541300","type":"CDM"},{"code":"00172541300","type":"NDC"}],"standard_charges":[{"gross_charge":20.44,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541360","type":"CDM"},{"code":"00172541360","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CROMOLYN SODIUM SOLN NEBU 20 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00172640649","type":"CDM"},{"code":"J7631","type":"HCPCS"},{"code":"00172640649","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BECLOMETHASONE DIPROPIONATE MONOHYD NASAL SUSP 42 MCG/SPRAY","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx00173038879","type":"CDM"},{"code":"00173038879","type":"NDC"}],"standard_charges":[{"gross_charge":400.57,"discounted_cash":140.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00173066518","type":"CDM"},{"code":"00173066518","type":"NDC"}],"standard_charges":[{"gross_charge":49.69,"discounted_cash":17.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATOVAQUONE-PROGUANIL HCL TAB 250-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173067502","type":"CDM"},{"code":"00173067502","type":"NDC"}],"standard_charges":[{"gross_charge":9.44,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":18.0,"type":"GM"},"code_information":[{"code":"Rx00173068220","type":"CDM"},{"code":"00173068220","type":"NDC"}],"standard_charges":[{"gross_charge":78.4,"discounted_cash":27.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx00173068221","type":"CDM"},{"code":"00173068221","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx00173068224","type":"CDM"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"gross_charge":30.93,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173071204","type":"CDM"},{"code":"00173071204","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173071215","type":"CDM"},{"code":"00173071215","type":"NDC"}],"standard_charges":[{"gross_charge":11.47,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUTICASONE PROPIONATE HFA INHAL AERO 44 MCG/ACT","drug_information":{"unit":10.6,"type":"GM"},"code_information":[{"code":"Rx00173071820","type":"CDM"},{"code":"00173071820","type":"NDC"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUTICASONE PROPIONATE HFA INHAL AER 110 MCG/ACT","drug_information":{"unit":12.0,"type":"GM"},"code_information":[{"code":"Rx00173071920","type":"CDM"},{"code":"00173071920","type":"NDC"}],"standard_charges":[{"gross_charge":340.03,"discounted_cash":119.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUTICASONE PROPIONATE HFA INHAL AER 220 MCG/ACT","drug_information":{"unit":12.0,"type":"GM"},"code_information":[{"code":"Rx00173072020","type":"CDM"},{"code":"00173072020","type":"NDC"}],"standard_charges":[{"gross_charge":528.17,"discounted_cash":184.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"UMECLIDINIUM-VILANTEROL AERO POWD BA 62.5-25 MCG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173086906","type":"CDM"},{"code":"00173086906","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":2.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00173095396","type":"CDM"},{"code":"00173095396","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185005501","type":"CDM"},{"code":"00185005501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185012801","type":"CDM"},{"code":"00185012801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185014501","type":"CDM"},{"code":"00185014501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185084201","type":"CDM"},{"code":"00185084201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185505001","type":"CDM"},{"code":"00185505001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT","drug_information":{"unit":6.0,"type":"GM"},"code_information":[{"code":"Rx00186037028","type":"CDM"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"gross_charge":83.9,"discounted_cash":29.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT","drug_information":{"unit":6.9,"type":"GM"},"code_information":[{"code":"Rx00186037228","type":"CDM"},{"code":"00186037228","type":"NDC"}],"standard_charges":[{"gross_charge":83.9,"discounted_cash":29.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077739","type":"CDM"},{"code":"00186077739","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077760","type":"CDM"},{"code":"00186077760","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 1 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00186199004","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00186199004","type":"NDC"}],"standard_charges":[{"gross_charge":14.14,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00187430202","type":"CDM"},{"code":"00187430202","type":"NDC"}],"standard_charges":[{"gross_charge":3114.38,"discounted_cash":1090.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228207610","type":"CDM"},{"code":"00228207610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228212710","type":"CDM"},{"code":"00228212710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPYLTHIOURACIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228234810","type":"CDM"},{"code":"00228234810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228253810","type":"CDM"},{"code":"00228253810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228257111","type":"CDM"},{"code":"00228257111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228305911","type":"CDM"},{"code":"00228305911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228306311","type":"CDM"},{"code":"00228306311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB ER 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228348211","type":"CDM"},{"code":"00228348211","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":2.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM IODIDE ORAL SOLN 1 GM/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00245000331","type":"CDM"},{"code":"00245000331","type":"NDC"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001201","type":"CDM"},{"code":"00245001201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001289","type":"CDM"},{"code":"00245001289","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001301","type":"CDM"},{"code":"00245001301","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001389","type":"CDM"},{"code":"00245001389","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245003689","type":"CDM"},{"code":"00245003689","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014701","type":"CDM"},{"code":"00245014701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245021111","type":"CDM"},{"code":"00245021111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245036001","type":"CDM"},{"code":"00245036001","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE TAB ER 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531689","type":"CDM"},{"code":"00245531689","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531701","type":"CDM"},{"code":"00245531701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531789","type":"CDM"},{"code":"00245531789","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531901","type":"CDM"},{"code":"00245531901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531911","type":"CDM"},{"code":"00245531911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531989","type":"CDM"},{"code":"00245531989","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALVIMOPAN CAP 12 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00254301255","type":"CDM"},{"code":"00254301255","type":"NDC"}],"standard_charges":[{"gross_charge":158.8,"discounted_cash":55.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LUBIPROSTONE CAP 24 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00254302902","type":"CDM"},{"code":"00254302902","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00264405090","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"00264405090","type":"NDC"}],"standard_charges":[{"gross_charge":244.9,"discounted_cash":85.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264410090","type":"CDM"},{"code":"J0136","type":"HCPCS"},{"code":"00264410090","type":"NDC"}],"standard_charges":[{"gross_charge":245.3,"discounted_cash":85.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00264410090","type":"CDM"},{"code":"J0136","type":"HCPCS"},{"code":"00264410090","type":"NDC"}],"standard_charges":[{"gross_charge":96.37,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264420654","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00264420654","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264440054","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00264440054","type":"NDC"}],"standard_charges":[{"gross_charge":243.2,"discounted_cash":85.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264446010","type":"CDM"},{"code":"00264446010","type":"NDC"}],"standard_charges":[{"gross_charge":250.25,"discounted_cash":87.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264446030","type":"CDM"},{"code":"00264446030","type":"NDC"}],"standard_charges":[{"gross_charge":284.2,"discounted_cash":99.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264553532","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00264553532","type":"NDC"}],"standard_charges":[{"gross_charge":243.7,"discounted_cash":85.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264780510","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00264780510","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264934155","type":"CDM"},{"code":"00264934155","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264959820","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00264959820","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00270055615","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"00270055615","type":"NDC"}],"standard_charges":[{"gross_charge":1366.55,"discounted_cash":478.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 61%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00270131530","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131530","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFUR HEXAFLUORIDE LIPID-TYPE A MICROS FOR SUSP 60.7-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00270709916","type":"CDM"},{"code":"Q9950","type":"HCPCS"},{"code":"00270709916","type":"NDC"}],"standard_charges":[{"gross_charge":348.21,"discounted_cash":121.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00281032608","type":"CDM"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN OINT 2%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00281032630","type":"CDM"},{"code":"00281032630","type":"NDC"}],"standard_charges":[{"gross_charge":46.84,"discounted_cash":16.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310110530","type":"CDM"},{"code":"00310110530","type":"NDC"}],"standard_charges":[{"gross_charge":24.48,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310110539","type":"CDM"},{"code":"00310110539","type":"NDC"}],"standard_charges":[{"gross_charge":24.48,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310111039","type":"CDM"},{"code":"00310111039","type":"NDC"}],"standard_charges":[{"gross_charge":24.48,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338000403","type":"CDM"},{"code":"00338000403","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338000404","type":"CDM"},{"code":"00338000404","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338001306","type":"CDM"},{"code":"00338001306","type":"NDC"}],"standard_charges":[{"gross_charge":99.25,"discounted_cash":34.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004803","type":"CDM"},{"code":"00338004803","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338004804","type":"CDM"},{"code":"00338004804","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004902","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004902","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004903","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338004903","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338004904","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00338004904","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338004941","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004941","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004948","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004948","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338005403","type":"CDM"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338005403","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00338007225","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00338007225","type":"NDC"}],"standard_charges":[{"gross_charge":93.47,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338010504","type":"CDM"},{"code":"00338010504","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338011703","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338011703","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338011704","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) IN NACL 0.9% IV SOLN 100 UNIT/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338012612","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00338012612","type":"NDC"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-A SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338017904","type":"CDM"},{"code":"00338017904","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-A SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338017904","type":"CDM"},{"code":"00338017904","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THROMBIN (RECOMBINANT) FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00338032201","type":"CDM"},{"code":"00338032201","type":"NDC"}],"standard_charges":[{"gross_charge":454.83,"discounted_cash":159.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00338035702","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00338035702","type":"NDC"}],"standard_charges":[{"gross_charge":246.43,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338041102","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00338041102","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINO ACID INFUSION 15%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338050206","type":"CDM"},{"code":"00338050206","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 0.8 MG/ML","drug_information":{"unit":133.333,"type":"ML"},"code_information":[{"code":"Rx00338050348","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050348","type":"NDC"}],"standard_charges":[{"gross_charge":243.56,"discounted_cash":85.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1.2 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338050741","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050741","type":"NDC"}],"standard_charges":[{"gross_charge":242.65,"discounted_cash":84.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1.2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338050748","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050748","type":"NDC"}],"standard_charges":[{"gross_charge":243.2,"discounted_cash":85.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 1.6 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338050941","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338050941","type":"NDC"}],"standard_charges":[{"gross_charge":242.75,"discounted_cash":84.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN IN SALINE INJ 2 MG/ML","drug_information":{"unit":80.0,"type":"ML"},"code_information":[{"code":"Rx00338051141","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00338051141","type":"NDC"}],"standard_charges":[{"gross_charge":244.34,"discounted_cash":85.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338051909","type":"CDM"},{"code":"00338051909","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338055311","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055311","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338055318","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338064406","type":"CDM"},{"code":"00338064406","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETIC ACID IRRIGATION SOLN 0.25%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338065604","type":"CDM"},{"code":"00338065604","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338067104","type":"CDM"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338070341","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070341","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338070434","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070434","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338070541","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070541","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338070548","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070548","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338070948","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"gross_charge":243.1,"discounted_cash":85.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338080304","type":"CDM"},{"code":"00338080304","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338100702","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":87.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338100703","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00338100703","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 3.2 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338100902","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00338100902","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM INJ 60000 UNIT/ML IN DEXTROSE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338102541","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00338102541","type":"NDC"}],"standard_charges":[{"gross_charge":243.1,"discounted_cash":85.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338104902","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00338104902","type":"NDC"}],"standard_charges":[{"gross_charge":131.6,"discounted_cash":46.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338105548","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":242.1,"discounted_cash":84.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338105548","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":241.3,"discounted_cash":84.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338107702","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00338107702","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00338130501","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"00338130501","type":"NDC"}],"standard_charges":[{"gross_charge":366.99,"discounted_cash":128.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338361224","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338361224","type":"NDC"}],"standard_charges":[{"gross_charge":245.4,"discounted_cash":85.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00338604537","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00338604537","type":"NDC"}],"standard_charges":[{"gross_charge":246.9,"discounted_cash":86.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338604648","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00338604648","type":"NDC"}],"standard_charges":[{"gross_charge":246.3,"discounted_cash":86.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954001","type":"CDM"},{"code":"00338954001","type":"NDC"}],"standard_charges":[{"gross_charge":858.4,"discounted_cash":300.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954006","type":"CDM"},{"code":"00338954006","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338955712","type":"CDM"},{"code":"00338955712","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338960001","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338960001","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLORAZEPATE DIPOTASSIUM TAB 3.75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378003001","type":"CDM"},{"code":"00378003001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378004701","type":"CDM"},{"code":"00378004701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDAPAMIDE TAB 1.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378006901","type":"CDM"},{"code":"00378006901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378007801","type":"CDM"},{"code":"00378007801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378008801","type":"CDM"},{"code":"00378008801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378014701","type":"CDM"},{"code":"00378014701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROBENECID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378015601","type":"CDM"},{"code":"00378015601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378018101","type":"CDM"},{"code":"00378018101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378021601","type":"CDM"},{"code":"00378021601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378027493","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00378027493","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378061201","type":"CDM"},{"code":"00378061201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087199","type":"CDM"},{"code":"00378087199","type":"NDC"}],"standard_charges":[{"gross_charge":36.44,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087299","type":"CDM"},{"code":"00378087299","type":"NDC"}],"standard_charges":[{"gross_charge":61.35,"discounted_cash":21.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378104901","type":"CDM"},{"code":"00378104901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378116001","type":"CDM"},{"code":"00378116001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180077","type":"CDM"},{"code":"00378180077","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180577","type":"CDM"},{"code":"00378180577","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BROMOCRIPTINE MESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378204293","type":"CDM"},{"code":"00378204293","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378207501","type":"CDM"},{"code":"00378207501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378232101","type":"CDM"},{"code":"00378232101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378266001","type":"CDM"},{"code":"00378266001","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378312501","type":"CDM"},{"code":"00378312501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.025 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378334916","type":"CDM"},{"code":"00378334916","type":"NDC"}],"standard_charges":[{"gross_charge":25.89,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378335099","type":"CDM"},{"code":"00378335099","type":"NDC"}],"standard_charges":[{"gross_charge":25.89,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378335299","type":"CDM"},{"code":"00378335299","type":"NDC"}],"standard_charges":[{"gross_charge":25.89,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.0375 MG/24HR (37.5 MCG/24HR)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378336099","type":"CDM"},{"code":"00378336099","type":"NDC"}],"standard_charges":[{"gross_charge":25.89,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378392593","type":"CDM"},{"code":"00378392593","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378401001","type":"CDM"},{"code":"00378401001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378401005","type":"CDM"},{"code":"00378401005","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378427577","type":"CDM"},{"code":"00378427577","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLURAZEPAM HCL CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378443001","type":"CDM"},{"code":"00378443001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378464026","type":"CDM"},{"code":"00378464026","type":"NDC"}],"standard_charges":[{"gross_charge":12.49,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EXEMESTANE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378500193","type":"CDM"},{"code":"00378500193","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIZATIDINE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378515091","type":"CDM"},{"code":"00378515091","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378530501","type":"CDM"},{"code":"00378530501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378530505","type":"CDM"},{"code":"00378530505","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378557593","type":"CDM"},{"code":"00378557593","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378580793","type":"CDM"},{"code":"00378580793","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378581377","type":"CDM"},{"code":"00378581377","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378600401","type":"CDM"},{"code":"00378600401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378606001","type":"CDM"},{"code":"00378606001","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378623201","type":"CDM"},{"code":"00378623201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378638001","type":"CDM"},{"code":"00378638001","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378660501","type":"CDM"},{"code":"00378660501","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378698789","type":"CDM"},{"code":"00378698789","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378699789","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00378699789","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378715501","type":"CDM"},{"code":"00378715501","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUVASTATIN SODIUM CAP 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378802077","type":"CDM"},{"code":"00378802077","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUVASTATIN SODIUM CAP 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378802177","type":"CDM"},{"code":"00378802177","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876516","type":"CDM"},{"code":"00378876516","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876593","type":"CDM"},{"code":"00378876593","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 4-1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876616","type":"CDM"},{"code":"J0573","type":"HCPCS"},{"code":"00378876616","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 4-1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876693","type":"CDM"},{"code":"J0573","type":"HCPCS"},{"code":"00378876693","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx00378877035","type":"CDM"},{"code":"00378877035","type":"NDC"}],"standard_charges":[{"gross_charge":217.26,"discounted_cash":76.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378908001","type":"CDM"},{"code":"00378908001","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.1 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910293","type":"CDM"},{"code":"00378910293","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910493","type":"CDM"},{"code":"00378910493","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911216","type":"CDM"},{"code":"00378911216","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911293","type":"CDM"},{"code":"00378911293","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911616","type":"CDM"},{"code":"00378911616","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911693","type":"CDM"},{"code":"00378911693","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378967131","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00378967131","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012323","type":"CDM"},{"code":"00406012323","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012362","type":"CDM"},{"code":"00406012362","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012423","type":"CDM"},{"code":"00406012423","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012462","type":"CDM"},{"code":"00406012462","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012562","type":"CDM"},{"code":"00406012562","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406036623","type":"CDM"},{"code":"00406036623","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406036662","type":"CDM"},{"code":"00406036662","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406048423","type":"CDM"},{"code":"00406048423","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406048450","type":"CDM"},{"code":"00406048450","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406048462","type":"CDM"},{"code":"00406048462","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051201","type":"CDM"},{"code":"00406051201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051205","type":"CDM"},{"code":"00406051205","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051223","type":"CDM"},{"code":"00406051223","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051262","type":"CDM"},{"code":"00406051262","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406055201","type":"CDM"},{"code":"00406055201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406055223","type":"CDM"},{"code":"00406055223","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406055262","type":"CDM"},{"code":"00406055262","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406114201","type":"CDM"},{"code":"00406114201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406114401","type":"CDM"},{"code":"00406114401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406123601","type":"CDM"},{"code":"00406123601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406324301","type":"CDM"},{"code":"00406324301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406324401","type":"CDM"},{"code":"00406324401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00406412303","type":"CDM"},{"code":"00406412303","type":"NDC"}],"standard_charges":[{"gross_charge":28.3,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406511862","type":"CDM"},{"code":"00406511862","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406575523","type":"CDM"},{"code":"00406575523","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406575562","type":"CDM"},{"code":"00406575562","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406577101","type":"CDM"},{"code":"00406577101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406577123","type":"CDM"},{"code":"00406577123","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406577162","type":"CDM"},{"code":"00406577162","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00406800330","type":"CDM"},{"code":"00406800330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406831501","type":"CDM"},{"code":"00406831501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406831523","type":"CDM"},{"code":"00406831523","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406833001","type":"CDM"},{"code":"00406833001","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406833023","type":"CDM"},{"code":"00406833023","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406838001","type":"CDM"},{"code":"00406838001","type":"NDC"}],"standard_charges":[{"gross_charge":3.46,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406839001","type":"CDM"},{"code":"00406839001","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":1.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROAMPHETAMINE SULFATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406895901","type":"CDM"},{"code":"00406895901","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141208","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141208","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141230","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141230","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141233","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141233","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141361","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141361","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141491","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141491","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IODIXANOL INJ 270 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222216","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222216","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222306","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222306","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407222316","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222316","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407222364","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222364","type":"NDC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PERFLUTREN PROTEIN-TYPE A MICROSPHERES IV SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00407270703","type":"CDM"},{"code":"Q9956","type":"HCPCS"},{"code":"00407270703","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409015201","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015201","type":"NDC"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409015201","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015201","type":"NDC"}],"standard_charges":[{"gross_charge":241.25,"discounted_cash":84.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409015224","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015224","type":"NDC"}],"standard_charges":[{"gross_charge":241.2,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL INJ 2 GM/52.6ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":52.6,"type":"ML"},"code_information":[{"code":"Rx00409018201","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018201","type":"NDC"}],"standard_charges":[{"gross_charge":650.66,"discounted_cash":227.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409018501","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018501","type":"NDC"}],"standard_charges":[{"gross_charge":288.23,"discounted_cash":100.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 20 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409020102","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00409020102","type":"NDC"}],"standard_charges":[{"gross_charge":735.07,"discounted_cash":257.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409082911","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00409082911","type":"NDC"}],"standard_charges":[{"gross_charge":297.08,"discounted_cash":103.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409103630","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"00409103630","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":1.33333333333333,"type":"ML"},"code_information":[{"code":"Rx00409104130","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"00409104130","type":"NDC"}],"standard_charges":[{"gross_charge":93.41,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409106720","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"00409106720","type":"NDC"}],"standard_charges":[{"gross_charge":94.11,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00409110301","type":"CDM"},{"code":"00409110301","type":"NDC"}],"standard_charges":[{"gross_charge":94.52,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATRACURIUM BESYLATE IV SOLN 100 MG/10ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409110502","type":"CDM"},{"code":"00409110502","type":"NDC"}],"standard_charges":[{"gross_charge":95.49,"discounted_cash":33.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115901","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":94.2,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115902","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115902","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115919","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115919","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116201","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116201","type":"NDC"}],"standard_charges":[{"gross_charge":94.37,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116202","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":93.6,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409117630","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409117630","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120703","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120703","type":"NDC"}],"standard_charges":[{"gross_charge":96.43,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120713","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120713","type":"NDC"}],"standard_charges":[{"gross_charge":94.02,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409121501","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409121501","type":"NDC"}],"standard_charges":[{"gross_charge":96.77,"discounted_cash":33.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128331","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128331","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409132305","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409132305","type":"NDC"}],"standard_charges":[{"gross_charge":99.13,"discounted_cash":34.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409132315","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409132315","type":"NDC"}],"standard_charges":[{"gross_charge":96.03,"discounted_cash":33.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141204","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141204","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141210","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141210","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141249","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141249","type":"NDC"}],"standard_charges":[{"gross_charge":94.12,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146301","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146301","type":"NDC"}],"standard_charges":[{"gross_charge":96.37,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146349","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146349","type":"NDC"}],"standard_charges":[{"gross_charge":96.37,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALBUPHINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146501","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146501","type":"NDC"}],"standard_charges":[{"gross_charge":98.14,"discounted_cash":34.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409155910","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409155910","type":"NDC"}],"standard_charges":[{"gross_charge":95.1,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409155918","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409155918","type":"NDC"}],"standard_charges":[{"gross_charge":94.7,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409156010","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409156010","type":"NDC"}],"standard_charges":[{"gross_charge":95.42,"discounted_cash":33.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409162301","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162301","type":"NDC"}],"standard_charges":[{"gross_charge":166.4,"discounted_cash":58.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162601","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162601","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162602","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162602","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409163010","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"gross_charge":96.77,"discounted_cash":33.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409163401","type":"CDM"},{"code":"00409163401","type":"NDC"}],"standard_charges":[{"gross_charge":138.54,"discounted_cash":48.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409163802","type":"CDM"},{"code":"00409163802","type":"NDC"}],"standard_charges":[{"gross_charge":98.47,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174610","type":"CDM"},{"code":"00409174610","type":"NDC"}],"standard_charges":[{"gross_charge":96.17,"discounted_cash":33.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174630","type":"CDM"},{"code":"00409174630","type":"NDC"}],"standard_charges":[{"gross_charge":94.93,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174929","type":"CDM"},{"code":"00409174929","type":"NDC"}],"standard_charges":[{"gross_charge":94.67,"discounted_cash":33.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409176110","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409176110","type":"NDC"}],"standard_charges":[{"gross_charge":95.06,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409177510","type":"CDM"},{"code":"00409177510","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409177805","type":"CDM"},{"code":"00409177805","type":"NDC"}],"standard_charges":[{"gross_charge":93.68,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409177815","type":"CDM"},{"code":"00409177815","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409188602","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409188602","type":"NDC"}],"standard_charges":[{"gross_charge":95.11,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409188622","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409188622","type":"NDC"}],"standard_charges":[{"gross_charge":94.44,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189001","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189023","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189023","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189301","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189301","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409190201","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"00409190201","type":"NDC"}],"standard_charges":[{"gross_charge":4179.16,"discounted_cash":1462.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 500 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409190301","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"00409190301","type":"NDC"}],"standard_charges":[{"gross_charge":517.39,"discounted_cash":181.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409196607","type":"CDM"},{"code":"00409196607","type":"NDC"}],"standard_charges":[{"gross_charge":94.21,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409198530","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409202902","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409202902","type":"NDC"}],"standard_charges":[{"gross_charge":128.36,"discounted_cash":44.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409205020","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409205020","type":"NDC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205105","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205115","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205115","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409216877","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409216877","type":"NDC"}],"standard_charges":[{"gross_charge":94.06,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409222024","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00409222024","type":"NDC"}],"standard_charges":[{"gross_charge":244.4,"discounted_cash":85.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409226720","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409226720","type":"NDC"}],"standard_charges":[{"gross_charge":93.43,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409226754","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409226754","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230801","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230802","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230802","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230821","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230821","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230822","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230822","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230869","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230869","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409233725","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"00409233725","type":"NDC"}],"standard_charges":[{"gross_charge":416.92,"discounted_cash":145.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409233934","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"gross_charge":96.43,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409259603","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409259603","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409259653","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409259653","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409272002","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":93.85,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409272002","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":96.27,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409272301","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272301","type":"NDC"}],"standard_charges":[{"gross_charge":93.37,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409302401","type":"CDM"},{"code":"00409302401","type":"NDC"}],"standard_charges":[{"gross_charge":444.19,"discounted_cash":155.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409318201","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318201","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409330024","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":246.9,"discounted_cash":86.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409330803","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00409330803","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409336501","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409336501","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409341401","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341401","type":"NDC"}],"standard_charges":[{"gross_charge":94.38,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341411","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341411","type":"NDC"}],"standard_charges":[{"gross_charge":93.81,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409351501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409351501","type":"NDC"}],"standard_charges":[{"gross_charge":127.45,"discounted_cash":44.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409371801","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00409371801","type":"NDC"}],"standard_charges":[{"gross_charge":93.46,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409372432","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409372432","type":"NDC"}],"standard_charges":[{"gross_charge":307.4,"discounted_cash":107.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00409379501","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379501","type":"NDC"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00409379601","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379601","type":"NDC"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409381511","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409381511","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409381512","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409381512","type":"NDC"}],"standard_charges":[{"gross_charge":249.67,"discounted_cash":87.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECT, BACTERIOSTATIC BENZYL ALCOHOL","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409397701","type":"CDM"},{"code":"00409397701","type":"NDC"}],"standard_charges":[{"gross_charge":95.05,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECT, BACTERIOSTATIC BENZYL ALCOHOL","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409397703","type":"CDM"},{"code":"00409397703","type":"NDC"}],"standard_charges":[{"gross_charge":95.05,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MANNITOL IV SOLN 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409403101","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00409403101","type":"NDC"}],"standard_charges":[{"gross_charge":94.95,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MANGANESE CHLORIDE INJ 0.1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409101","type":"CDM"},{"code":"00409409101","type":"NDC"}],"standard_charges":[{"gross_charge":333.87,"discounted_cash":116.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CUPRIC CHLORIDE INJ 0.4 MG/ML (ELEMENTAL)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409201","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409409201","type":"NDC"}],"standard_charges":[{"gross_charge":319.2,"discounted_cash":111.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHROMIC CHLORIDE INJ 40 MCG/10ML (4 MCG/ML) (ELEMENTAL CR)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409409301","type":"CDM"},{"code":"00409409301","type":"NDC"}],"standard_charges":[{"gross_charge":203.61,"discounted_cash":71.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409419103","type":"CDM"},{"code":"00409419103","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409420801","type":"CDM"},{"code":"00409420801","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426411","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426411","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427601","type":"CDM"},{"code":"00409427601","type":"NDC"}],"standard_charges":[{"gross_charge":93.29,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409427801","type":"CDM"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":93.67,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427902","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":93.3,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427916","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409427916","type":"NDC"}],"standard_charges":[{"gross_charge":93.3,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409428202","type":"CDM"},{"code":"00409428202","type":"NDC"}],"standard_charges":[{"gross_charge":93.44,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409428301","type":"CDM"},{"code":"00409428301","type":"NDC"}],"standard_charges":[{"gross_charge":96.04,"discounted_cash":33.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409433201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409433201","type":"NDC"}],"standard_charges":[{"gross_charge":100.47,"discounted_cash":35.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409433211","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409433211","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409434673","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00409434673","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV FOR SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409435003","type":"CDM"},{"code":"00409435003","type":"NDC"}],"standard_charges":[{"gross_charge":101.3,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409444401","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00409444401","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":87.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409444424","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00409444424","type":"NDC"}],"standard_charges":[{"gross_charge":249.5,"discounted_cash":87.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409468822","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468822","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409468823","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468823","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409468823","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468823","type":"NDC"}],"standard_charges":[{"gross_charge":247.4,"discounted_cash":86.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409469933","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469933","type":"NDC"}],"standard_charges":[{"gross_charge":97.4,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409471332","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409471332","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409471342","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409471342","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409475503","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00409475503","type":"NDC"}],"standard_charges":[{"gross_charge":94.42,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409477702","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477702","type":"NDC"}],"standard_charges":[{"gross_charge":243.7,"discounted_cash":85.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477702","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477702","type":"NDC"}],"standard_charges":[{"gross_charge":242.1,"discounted_cash":84.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488710","type":"CDM"},{"code":"00409488710","type":"NDC"}],"standard_charges":[{"gross_charge":93.83,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488717","type":"CDM"},{"code":"00409488717","type":"NDC"}],"standard_charges":[{"gross_charge":93.79,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488720","type":"CDM"},{"code":"00409488720","type":"NDC"}],"standard_charges":[{"gross_charge":94.55,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409488750","type":"CDM"},{"code":"00409488750","type":"NDC"}],"standard_charges":[{"gross_charge":98.05,"discounted_cash":34.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409488799","type":"CDM"},{"code":"00409488799","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488802","type":"CDM"},{"code":"00409488802","type":"NDC"}],"standard_charges":[{"gross_charge":93.29,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488810","type":"CDM"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":94.11,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 50 MG/5ML (1%),LIDOCAINE HCL (CARDIAC) IV PF SOLN PREF SYR 50 MG/5ML(1%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/10ML (1%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/10ML (1%)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409490434","type":"CDM"},{"code":"00409490434","type":"NDC"}],"standard_charges":[{"gross_charge":100.45,"discounted_cash":35.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409492834","type":"CDM"},{"code":"00409492834","type":"NDC"}],"standard_charges":[{"gross_charge":175.05,"discounted_cash":61.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508216","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508216","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508411","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508411","type":"NDC"}],"standard_charges":[{"gross_charge":97.09,"discounted_cash":33.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409553434","type":"CDM"},{"code":"00409553434","type":"NDC"}],"standard_charges":[{"gross_charge":103.25,"discounted_cash":36.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555501","type":"CDM"},{"code":"00409555501","type":"NDC"}],"standard_charges":[{"gross_charge":97.29,"discounted_cash":34.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555502","type":"CDM"},{"code":"00409555502","type":"NDC"}],"standard_charges":[{"gross_charge":100.35,"discounted_cash":35.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409555512","type":"CDM"},{"code":"00409555512","type":"NDC"}],"standard_charges":[{"gross_charge":96.96,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409582001","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409582001","type":"NDC"}],"standard_charges":[{"gross_charge":96.83,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409582011","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409582011","type":"NDC"}],"standard_charges":[{"gross_charge":95.78,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409592101","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":201.48,"discounted_cash":70.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409592116","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592116","type":"NDC"}],"standard_charges":[{"gross_charge":125.77,"discounted_cash":44.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409592201","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"gross_charge":129.69,"discounted_cash":45.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409592216","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592216","type":"NDC"}],"standard_charges":[{"gross_charge":100.23,"discounted_cash":35.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409610202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":96.99,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":95.12,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610204","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":93.9,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610210","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610218","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610218","type":"NDC"}],"standard_charges":[{"gross_charge":93.41,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610219","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610219","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610236","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610236","type":"NDC"}],"standard_charges":[{"gross_charge":93.41,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409613822","type":"CDM"},{"code":"00409613822","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETIC ACID IRRIGATION SOLN 0.25%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409614309","type":"CDM"},{"code":"00409614309","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN LACTOBIONATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409647644","type":"CDM"},{"code":"J1364","type":"HCPCS"},{"code":"00409647644","type":"NDC"}],"standard_charges":[{"gross_charge":215.65,"discounted_cash":75.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409650901","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409650901","type":"NDC"}],"standard_charges":[{"gross_charge":910.67,"discounted_cash":318.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409651001","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409651001","type":"NDC"}],"standard_charges":[{"gross_charge":291.76,"discounted_cash":102.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653112","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653112","type":"NDC"}],"standard_charges":[{"gross_charge":100.09,"discounted_cash":35.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653301","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653301","type":"NDC"}],"standard_charges":[{"gross_charge":95.85,"discounted_cash":33.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662502","type":"CDM"},{"code":"00409662502","type":"NDC"}],"standard_charges":[{"gross_charge":97.22,"discounted_cash":34.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662522","type":"CDM"},{"code":"00409662522","type":"NDC"}],"standard_charges":[{"gross_charge":97.6,"discounted_cash":34.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 200 MG/10ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 140 MG/7ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 200 MG/10ML (20 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00409662902","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00409662902","type":"NDC"}],"standard_charges":[{"gross_charge":94.82,"discounted_cash":33.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409663734","type":"CDM"},{"code":"00409663734","type":"NDC"}],"standard_charges":[{"gross_charge":102.3,"discounted_cash":35.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409664802","type":"CDM"},{"code":"00409664802","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409664816","type":"CDM"},{"code":"00409664816","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409672903","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672903","type":"NDC"}],"standard_charges":[{"gross_charge":245.5,"discounted_cash":85.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 40 GM/1000ML (40 MG/ML)","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409672909","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672909","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409672923","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672923","type":"NDC"}],"standard_charges":[{"gross_charge":247.3,"discounted_cash":86.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML),MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409672924","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672924","type":"NDC"}],"standard_charges":[{"gross_charge":242.45,"discounted_cash":84.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409677802","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409677802","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409707514","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409707514","type":"NDC"}],"standard_charges":[{"gross_charge":244.95,"discounted_cash":85.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409707526","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409707526","type":"NDC"}],"standard_charges":[{"gross_charge":244.9,"discounted_cash":85.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409710102","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710102","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409710709","type":"CDM"},{"code":"00409710709","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409710909","type":"CDM"},{"code":"00409710909","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN D5W LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409711109","type":"CDM"},{"code":"00409711109","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409711509","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409711509","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ,KCL 40 MEQ/L (0.298%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409711609","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409711609","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINO ACID INFUSION 15%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00409712207","type":"CDM"},{"code":"00409712207","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409713809","type":"CDM"},{"code":"00409713809","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409713909","type":"CDM"},{"code":"00409713909","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409729501","type":"CDM"},{"code":"00409729501","type":"NDC"}],"standard_charges":[{"gross_charge":119.11,"discounted_cash":41.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409729973","type":"CDM"},{"code":"00409729973","type":"NDC"}],"standard_charges":[{"gross_charge":114.91,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409729983","type":"CDM"},{"code":"00409729983","type":"NDC"}],"standard_charges":[{"gross_charge":96.13,"discounted_cash":33.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733201","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733201","type":"NDC"}],"standard_charges":[{"gross_charge":94.58,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733211","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733211","type":"NDC"}],"standard_charges":[{"gross_charge":94.15,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733503","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733503","type":"NDC"}],"standard_charges":[{"gross_charge":95.78,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733701","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733701","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733801","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733801","type":"NDC"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":32.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409739172","type":"CDM"},{"code":"00409739172","type":"NDC"}],"standard_charges":[{"gross_charge":412.94,"discounted_cash":144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTRAN 40 INJ 10% IN D5W","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409741803","type":"CDM"},{"code":"J7100","type":"HCPCS"},{"code":"00409741803","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409751716","type":"CDM"},{"code":"00409751716","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409762003","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409762003","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765030","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765030","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765052","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765052","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765062","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765062","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/500ML-0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409765113","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765113","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE INJ 1.6 MG/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409780922","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409780922","type":"NDC"}],"standard_charges":[{"gross_charge":159.6,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"},{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 3.2 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409781022","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409781022","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409781124","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409781124","type":"NDC"}],"standard_charges":[{"gross_charge":242.3,"discounted_cash":84.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409781137","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409781137","type":"NDC"}],"standard_charges":[{"gross_charge":241.8,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.2% INJ,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.225% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790109","type":"CDM"},{"code":"00409790109","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409790203","type":"CDM"},{"code":"00409790203","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790209","type":"CDM"},{"code":"00409790209","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790309","type":"CDM"},{"code":"00409790309","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790409","type":"CDM"},{"code":"00409790409","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN DEXTROSE 5% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790509","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409790509","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 70%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409791819","type":"CDM"},{"code":"00409791819","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792202","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792202","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792203","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792203","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792209","type":"CDM"},{"code":"J7070","type":"HCPCS"},{"code":"00409792209","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409792261","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792261","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00409792261","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792261","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409792313","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792313","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792313","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792313","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792323","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792323","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409792323","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792323","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792336","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792336","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409792336","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792336","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409792337","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792337","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00409792337","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792337","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792402","type":"CDM"},{"code":"00409792402","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792403","type":"CDM"},{"code":"00409792403","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792409","type":"CDM"},{"code":"00409792409","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792603","type":"CDM"},{"code":"00409792603","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792609","type":"CDM"},{"code":"00409792609","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792903","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00409792903","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792909","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00409792909","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409793002","type":"CDM"},{"code":"00409793002","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409793009","type":"CDM"},{"code":"00409793009","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409793519","type":"CDM"},{"code":"00409793519","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409793619","type":"CDM"},{"code":"00409793619","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409793819","type":"CDM"},{"code":"00409793819","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409793819","type":"CDM"},{"code":"00409793819","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409794103","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00409794103","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409794109","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00409794109","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409795309","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00409795309","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION,ELECTROLYTE-A SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409796709","type":"CDM"},{"code":"00409796709","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00409797207","type":"CDM"},{"code":"00409797207","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798302","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798302","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798303","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00409798303","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409798309","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00409798309","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409798361","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798361","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409798413","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798413","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409798423","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798423","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409798436","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798436","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409798437","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798437","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798502","type":"CDM"},{"code":"00409798502","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798503","type":"CDM"},{"code":"00409798503","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409798509","type":"CDM"},{"code":"00409798509","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409799309","type":"CDM"},{"code":"00409799309","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYSTEINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409897510","type":"CDM"},{"code":"00409897510","type":"NDC"}],"standard_charges":[{"gross_charge":99.76,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904217","type":"CDM"},{"code":"00409904217","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904516","type":"CDM"},{"code":"00409904516","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904517","type":"CDM"},{"code":"00409904517","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909311","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909311","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909409","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909409","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909412","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909412","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 25 MCG/0.5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909422","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909431","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909431","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409910420","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409910420","type":"NDC"}],"standard_charges":[{"gross_charge":98.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409915701","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915701","type":"NDC"}],"standard_charges":[{"gross_charge":96.96,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409915731","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915731","type":"NDC"}],"standard_charges":[{"gross_charge":95.12,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915801","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":33.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409915801","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":98.25,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409955849","type":"CDM"},{"code":"00409955849","type":"NDC"}],"standard_charges":[{"gross_charge":93.92,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx00430375414","type":"CDM"},{"code":"00430375414","type":"NDC"}],"standard_charges":[{"gross_charge":474.17,"discounted_cash":165.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456040001","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456040001","type":"NDC"}],"standard_charges":[{"gross_charge":2165.91,"discounted_cash":758.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456040010","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456040010","type":"NDC"}],"standard_charges":[{"gross_charge":2088.69,"discounted_cash":731.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THYROID TAB 15 MG (1/4 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456045701","type":"CDM"},{"code":"00456045701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THYROID TAB 30 MG (1/2 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456045801","type":"CDM"},{"code":"00456045801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456060001","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456060001","type":"NDC"}],"standard_charges":[{"gross_charge":432.32,"discounted_cash":151.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456060010","type":"CDM"},{"code":"J0712","type":"HCPCS"},{"code":"00456060010","type":"NDC"}],"standard_charges":[{"gross_charge":2088.69,"discounted_cash":731.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME-AVIBACTAM SODIUM FOR IV SOLN 2.5 GM (2-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456270010","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270010","type":"NDC"}],"standard_charges":[{"gross_charge":4052.22,"discounted_cash":1418.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456320511","type":"CDM"},{"code":"00456320511","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456320563","type":"CDM"},{"code":"00456320563","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456321011","type":"CDM"},{"code":"00456321011","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456321063","type":"CDM"},{"code":"00456321063","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00469301601","type":"CDM"},{"code":"J7525","type":"HCPCS"},{"code":"00469301601","type":"NDC"}],"standard_charges":[{"gross_charge":2618.95,"discounted_cash":916.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHOTERICIN B LIPOSOME IV FOR SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469305130","type":"CDM"},{"code":"J0289","type":"HCPCS"},{"code":"00469305130","type":"NDC"}],"standard_charges":[{"gross_charge":1093.0,"discounted_cash":382.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00469823412","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00469823412","type":"NDC"}],"standard_charges":[{"gross_charge":377.75,"discounted_cash":132.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL SUPPOS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00472173803","type":"CDM"},{"code":"00472173803","type":"NDC"}],"standard_charges":[{"gross_charge":21.88,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LUBIPROSTONE CAP 8 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00480347906","type":"CDM"},{"code":"00480347906","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487020101","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00487020101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487900360","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"00487900360","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487930103","type":"CDM"},{"code":"00487930103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487930133","type":"CDM"},{"code":"00487930133","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00487950101","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487950101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00487950103","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487950103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00487970101","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00487980101","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00487980101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML)","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00487990130","type":"CDM"},{"code":"J7611","type":"HCPCS"},{"code":"00487990130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517037405","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037405","type":"NDC"}],"standard_charges":[{"gross_charge":903.72,"discounted_cash":316.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDIGOTINDISULFONATE SODIUM INJ 8 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00517037505","type":"CDM"},{"code":"J9220","type":"HCPCS"},{"code":"00517037505","type":"NDC"}],"standard_charges":[{"gross_charge":1613.41,"discounted_cash":564.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517072001","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"gross_charge":100.25,"discounted_cash":35.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517074020","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"00517074020","type":"NDC"}],"standard_charges":[{"gross_charge":229.42,"discounted_cash":80.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROGESTERONE IM IN OIL 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517075001","type":"CDM"},{"code":"J2675","type":"HCPCS"},{"code":"00517075001","type":"NDC"}],"standard_charges":[{"gross_charge":96.15,"discounted_cash":33.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML,ATROPINE SULFATE IV SOLN PREFILLED SYRINGE 0.4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517100401","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100401","type":"NDC"}],"standard_charges":[{"gross_charge":95.31,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML,ATROPINE SULFATE IV SOLN PREFILLED SYRINGE 0.4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517100425","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"gross_charge":95.29,"discounted_cash":33.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE INJ 1 MG/ML,ATROPINE SULFATE IV SOLN 1 MG/ML,ATROPINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00517101025","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00517101025","type":"NDC"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517234010","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":118.1,"discounted_cash":41.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517400201","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"00517400201","type":"NDC"}],"standard_charges":[{"gross_charge":425.1,"discounted_cash":148.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517481025","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00517481025","type":"NDC"}],"standard_charges":[{"gross_charge":135.85,"discounted_cash":47.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ACETATE INJ 4 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00517502325","type":"CDM"},{"code":"00517502325","type":"NDC"}],"standard_charges":[{"gross_charge":98.8,"discounted_cash":34.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZINC SULFATE INJ 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517611025","type":"CDM"},{"code":"00517611025","type":"NDC"}],"standard_charges":[{"gross_charge":163.52,"discounted_cash":57.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRACE MIN (CR-CU-MN-ZN) INJ 0.85-100-25-1500 MCG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517620225","type":"CDM"},{"code":"00517620225","type":"NDC"}],"standard_charges":[{"gross_charge":102.96,"discounted_cash":36.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00517912025","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"00517912025","type":"NDC"}],"standard_charges":[{"gross_charge":100.59,"discounted_cash":35.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRACE MIN (CU-MN-SE-ZN) INJ 300-55-60-3000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517930501","type":"CDM"},{"code":"00517930501","type":"NDC"}],"standard_charges":[{"gross_charge":176.47,"discounted_cash":61.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROBENECID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527136701","type":"CDM"},{"code":"00527136701","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00527142562","type":"CDM"},{"code":"00527142562","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ASPIRIN-CAFFEINE CAP 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527155201","type":"CDM"},{"code":"00527155201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527163201","type":"CDM"},{"code":"00527163201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOPINAVIR-RITONAVIR SOLN 400-100 MG/5ML (80-20 MG/ML)","drug_information":{"unit":160.0,"type":"ML"},"code_information":[{"code":"Rx00527194748","type":"CDM"},{"code":"00527194748","type":"NDC"}],"standard_charges":[{"gross_charge":499.44,"discounted_cash":174.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527224432","type":"CDM"},{"code":"00527224432","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527328143","type":"CDM"},{"code":"00527328143","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527328146","type":"CDM"},{"code":"00527328146","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEXILETINE HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527410737","type":"CDM"},{"code":"00527410737","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527411637","type":"CDM"},{"code":"00527411637","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527411737","type":"CDM"},{"code":"00527411737","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00527516082","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00527516082","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00527600480","type":"CDM"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":32.47,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548540000","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00548540000","type":"NDC"}],"standard_charges":[{"gross_charge":275.63,"discounted_cash":96.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00548560200","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560200","type":"NDC"}],"standard_charges":[{"gross_charge":98.95,"discounted_cash":34.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00548560400","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560400","type":"NDC"}],"standard_charges":[{"gross_charge":103.01,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00548560700","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00548560700","type":"NDC"}],"standard_charges":[{"gross_charge":203.11,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLUCAGON FOR INJ 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00548585000","type":"CDM"},{"code":"J1610","type":"HCPCS"},{"code":"00548585000","type":"NDC"}],"standard_charges":[{"gross_charge":2916.48,"discounted_cash":1020.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYALURONIDASE BOVINE INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548909010","type":"CDM"},{"code":"J3470","type":"HCPCS"},{"code":"00548909010","type":"NDC"}],"standard_charges":[{"gross_charge":345.04,"discounted_cash":120.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555003302","type":"CDM"},{"code":"00555003302","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555007101","type":"CDM"},{"code":"00555007101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555007102","type":"CDM"},{"code":"00555007102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555015802","type":"CDM"},{"code":"00555015802","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555015902","type":"CDM"},{"code":"00555015902","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555057202","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"00555057202","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555060602","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00555060602","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555077702","type":"CDM"},{"code":"00555077702","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555077902","type":"CDM"},{"code":"00555077902","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRETINOIN CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555080802","type":"CDM"},{"code":"00555080802","type":"NDC"}],"standard_charges":[{"gross_charge":36.98,"discounted_cash":12.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555087202","type":"CDM"},{"code":"00555087202","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555089902","type":"CDM"},{"code":"00555089902","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROAMPHETAMINE SULFATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555095302","type":"CDM"},{"code":"00555095302","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555097102","type":"CDM"},{"code":"00555097102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555097302","type":"CDM"},{"code":"00555097302","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555100901","type":"CDM"},{"code":"00555100901","type":"NDC"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555100916","type":"CDM"},{"code":"00555100916","type":"NDC"}],"standard_charges":[{"gross_charge":37.15,"discounted_cash":13.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555101016","type":"CDM"},{"code":"00555101016","type":"NDC"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.3 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555101101","type":"CDM"},{"code":"00555101101","type":"NDC"}],"standard_charges":[{"gross_charge":49.74,"discounted_cash":17.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.3 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555101116","type":"CDM"},{"code":"00555101116","type":"NDC"}],"standard_charges":[{"gross_charge":86.83,"discounted_cash":30.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORGESTREL & ETHINYL ESTRADIOL TAB 0.3 MG-30 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555904958","type":"CDM"},{"code":"00555904958","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BROMOCRIPTINE MESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010601","type":"CDM"},{"code":"00574010601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BROMOCRIPTINE MESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010603","type":"CDM"},{"code":"00574010603","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010770","type":"CDM"},{"code":"00574010770","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010777","type":"CDM"},{"code":"00574010777","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAFFEINE CITRATE ORAL SOLN 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00574015210","type":"CDM"},{"code":"00574015210","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00574015312","type":"CDM"},{"code":"00574015312","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00574015330","type":"CDM"},{"code":"00574015330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574022001","type":"CDM"},{"code":"00574022001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB ER 12HR 0.375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574025101","type":"CDM"},{"code":"00574025101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMILORIDE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574029201","type":"CDM"},{"code":"00574029201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574079201","type":"CDM"},{"code":"00574079201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00574082301","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"00574082301","type":"NDC"}],"standard_charges":[{"gross_charge":101.1,"discounted_cash":35.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00574085005","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00574085005","type":"NDC"}],"standard_charges":[{"gross_charge":1348.72,"discounted_cash":472.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE IV SOLN 50 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00574086610","type":"CDM"},{"code":"J7516","type":"HCPCS"},{"code":"00574086610","type":"NDC"}],"standard_charges":[{"gross_charge":401.85,"discounted_cash":140.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE SUSP 25 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00574113304","type":"CDM"},{"code":"00574113304","type":"NDC"}],"standard_charges":[{"gross_charge":8.84,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BELLADONNA ALKALOIDS & OPIUM SUPPOS 16.2-60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574704012","type":"CDM"},{"code":"00574704012","type":"NDC"}],"standard_charges":[{"gross_charge":36.8,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BELLADONNA ALKALOIDS & OPIUM SUPPOS 16.2-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574704512","type":"CDM"},{"code":"00574704512","type":"NDC"}],"standard_charges":[{"gross_charge":30.27,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL SUPPOS 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574722406","type":"CDM"},{"code":"00574722406","type":"NDC"}],"standard_charges":[{"gross_charge":13.49,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574722612","type":"CDM"},{"code":"00574722612","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574985510","type":"CDM"},{"code":"00574985510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZOXIDE SUSP 50 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00575620030","type":"CDM"},{"code":"00575620030","type":"NDC"}],"standard_charges":[{"gross_charge":635.8,"discounted_cash":222.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591024110","type":"CDM"},{"code":"00591024110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591034301","type":"CDM"},{"code":"00591034301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591034501","type":"CDM"},{"code":"00591034501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591040401","type":"CDM"},{"code":"00591040401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591046301","type":"CDM"},{"code":"00591046301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591079601","type":"CDM"},{"code":"00591079601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00591207026","type":"CDM"},{"code":"00591207026","type":"NDC"}],"standard_charges":[{"gross_charge":9.93,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591222215","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00591222215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALVIMOPAN CAP 12 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591231215","type":"CDM"},{"code":"00591231215","type":"NDC"}],"standard_charges":[{"gross_charge":199.53,"discounted_cash":69.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591241630","type":"CDM"},{"code":"00591241630","type":"NDC"}],"standard_charges":[{"gross_charge":31.94,"discounted_cash":11.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591246501","type":"CDM"},{"code":"00591246501","type":"NDC"}],"standard_charges":[{"gross_charge":7.54,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUTAMIDE CAP 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591246618","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00591246618","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591247319","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00591247319","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFF W/ COD CAP 50-300-40-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591264101","type":"CDM"},{"code":"00591264101","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591288001","type":"CDM"},{"code":"00591288001","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591288201","type":"CDM"},{"code":"00591288201","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00591291839","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00591291839","type":"NDC"}],"standard_charges":[{"gross_charge":7.4,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROGESTERONE IM IN OIL 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00591312879","type":"CDM"},{"code":"J2675","type":"HCPCS"},{"code":"00591312879","type":"NDC"}],"standard_charges":[{"gross_charge":96.09,"discounted_cash":33.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321354","type":"CDM"},{"code":"00591321354","type":"NDC"}],"standard_charges":[{"gross_charge":60.36,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321372","type":"CDM"},{"code":"00591321372","type":"NDC"}],"standard_charges":[{"gross_charge":27.95,"discounted_cash":9.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ASPIRIN-CAFFEINE CAP 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591321901","type":"CDM"},{"code":"00591321901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00591322379","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00591322379","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591352511","type":"CDM"},{"code":"00591352511","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591352530","type":"CDM"},{"code":"00591352530","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXANDROLONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591354401","type":"CDM"},{"code":"00591354401","type":"NDC"}],"standard_charges":[{"gross_charge":6.14,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ASPIRIN-CAFF W/ CODEINE CAP 50-325-40-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591354601","type":"CDM"},{"code":"00591354601","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591367001","type":"CDM"},{"code":"00591367001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00591379830","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00591379830","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387045","type":"CDM"},{"code":"00591387045","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387545","type":"CDM"},{"code":"00591387545","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591533501","type":"CDM"},{"code":"00591533501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591533701","type":"CDM"},{"code":"00591533701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591544301","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00591544301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591562101","type":"CDM"},{"code":"00591562101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL INHAL AEROSOL SOLN 20-100 MCG/ACT","drug_information":{"unit":4.0,"type":"GM"},"code_information":[{"code":"Rx00597002402","type":"CDM"},{"code":"00597002402","type":"NDC"}],"standard_charges":[{"gross_charge":575.37,"discounted_cash":201.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TELMISARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597004037","type":"CDM"},{"code":"00597004037","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TELMISARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597004137","type":"CDM"},{"code":"00597004137","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEVIRAPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597004646","type":"CDM"},{"code":"00597004646","type":"NDC"}],"standard_charges":[{"gross_charge":16.79,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEVIRAPINE SUSP 50 MG/5ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00597004724","type":"CDM"},{"code":"00597004724","type":"NDC"}],"standard_charges":[{"gross_charge":22.74,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIOTROPIUM BROMIDE INHAL CAP 18 MCG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597007575","type":"CDM"},{"code":"00597007575","type":"NDC"}],"standard_charges":[{"gross_charge":13.11,"discounted_cash":4.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE HFA INHAL AEROSOL 17 MCG/ACT","drug_information":{"unit":12.9,"type":"GM"},"code_information":[{"code":"Rx00597008717","type":"CDM"},{"code":"00597008717","type":"NDC"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 110 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597010860","type":"CDM"},{"code":"00597010860","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597013560","type":"CDM"},{"code":"00597013560","type":"NDC"}],"standard_charges":[{"gross_charge":8.39,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597014960","type":"CDM"},{"code":"00597014960","type":"NDC"}],"standard_charges":[{"gross_charge":8.39,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015230","type":"CDM"},{"code":"00597015230","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015237","type":"CDM"},{"code":"00597015237","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015290","type":"CDM"},{"code":"00597015290","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IDARUCIZUMAB IV SOLN 2.5 GM/50ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00597019705","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00597019705","type":"NDC"}],"standard_charges":[{"gross_charge":56861.28,"discounted_cash":19901.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLUCAGON HCL (RDNA) DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597026010","type":"CDM"},{"code":"J1610","type":"HCPCS"},{"code":"00597026010","type":"NDC"}],"standard_charges":[{"gross_charge":1775.64,"discounted_cash":621.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597035556","type":"CDM"},{"code":"00597035556","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597036082","type":"CDM"},{"code":"00597036082","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603188016","type":"CDM"},{"code":"00603188016","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603221321","type":"CDM"},{"code":"00603221321","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603233821","type":"CDM"},{"code":"00603233821","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603233921","type":"CDM"},{"code":"00603233921","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603240621","type":"CDM"},{"code":"00603240621","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603294832","type":"CDM"},{"code":"00603294832","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603294921","type":"CDM"},{"code":"00603294921","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603321428","type":"CDM"},{"code":"00603321428","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603321521","type":"CDM"},{"code":"00603321521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603358121","type":"CDM"},{"code":"00603358121","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603358221","type":"CDM"},{"code":"00603358221","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603374421","type":"CDM"},{"code":"00603374421","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603389128","type":"CDM"},{"code":"00603389128","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603422402","type":"CDM"},{"code":"00603422402","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603448521","type":"CDM"},{"code":"00603448521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PERPHENAZINE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603506121","type":"CDM"},{"code":"Q0175","type":"HCPCS"},{"code":"00603506121","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL TAB 16.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603516521","type":"CDM"},{"code":"00603516521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603533521","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00603533521","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603533532","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00603533532","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603533921","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00603533921","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603646928","type":"CDM"},{"code":"00603646928","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":80.0,"type":"GM"},"code_information":[{"code":"Rx00603786290","type":"CDM"},{"code":"00603786290","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641012121","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641012121","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641012125","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641012125","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036721","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036721","type":"NDC"}],"standard_charges":[{"gross_charge":93.65,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036725","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641037625","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"00641037625","type":"NDC"}],"standard_charges":[{"gross_charge":93.72,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641040012","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00641040012","type":"NDC"}],"standard_charges":[{"gross_charge":93.39,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx00641047721","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047721","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641049321","type":"CDM"},{"code":"J1165","type":"HCPCS"},{"code":"00641049321","type":"NDC"}],"standard_charges":[{"gross_charge":93.96,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641092821","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641092821","type":"NDC"}],"standard_charges":[{"gross_charge":93.95,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641092825","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641092825","type":"NDC"}],"standard_charges":[{"gross_charge":94.76,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641139831","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139831","type":"NDC"}],"standard_charges":[{"gross_charge":100.16,"discounted_cash":35.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641139835","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":233.34,"discounted_cash":81.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641141031","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641141031","type":"NDC"}],"standard_charges":[{"gross_charge":93.89,"discounted_cash":32.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641141035","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"gross_charge":96.06,"discounted_cash":33.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641255541","type":"CDM"},{"code":"J1165","type":"HCPCS"},{"code":"00641255541","type":"NDC"}],"standard_charges":[{"gross_charge":93.84,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPYRIDAMOLE IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641256941","type":"CDM"},{"code":"J1245","type":"HCPCS"},{"code":"00641256941","type":"NDC"}],"standard_charges":[{"gross_charge":94.85,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML,LORAZEPAM INJ 4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641600125","type":"CDM"},{"code":"00641600125","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600710","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600710","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600810","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600810","type":"NDC"}],"standard_charges":[{"gross_charge":94.11,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00641601310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601310","type":"NDC"}],"standard_charges":[{"gross_charge":95.17,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601401","type":"CDM"},{"code":"00641601401","type":"NDC"}],"standard_charges":[{"gross_charge":93.67,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601501","type":"CDM"},{"code":"00641601501","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601510","type":"CDM"},{"code":"00641601510","type":"NDC"}],"standard_charges":[{"gross_charge":93.65,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641601910","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641601910","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641602701","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602701","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULF FOR MICROINFUSION PF INJ 200 MG/20ML (10MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00641603901","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641603901","type":"NDC"}],"standard_charges":[{"gross_charge":2213.08,"discounted_cash":774.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604401","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604401","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604601","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604601","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604825","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604825","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641605101","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641605101","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605201","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605201","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605225","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641605301","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605301","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641605325","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605325","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641606001","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641606101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606101","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641606110","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606110","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641606125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607801","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607801","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607825","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607825","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611610","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611610","type":"NDC"}],"standard_charges":[{"gross_charge":95.17,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611710","type":"NDC"}],"standard_charges":[{"gross_charge":96.36,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 15 (10-5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611801","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611801","type":"NDC"}],"standard_charges":[{"gross_charge":231.05,"discounted_cash":80.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641613225","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641613225","type":"NDC"}],"standard_charges":[{"gross_charge":94.07,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641614201","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614201","type":"NDC"}],"standard_charges":[{"gross_charge":96.17,"discounted_cash":33.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641614225","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":94.12,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641614910","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"gross_charge":95.08,"discounted_cash":33.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641615125","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641615125","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00641616401","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"00641616401","type":"NDC"}],"standard_charges":[{"gross_charge":96.55,"discounted_cash":33.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641616901","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641616901","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641616910","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641616910","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617410","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617410","type":"NDC"}],"standard_charges":[{"gross_charge":95.35,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617501","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617501","type":"NDC"}],"standard_charges":[{"gross_charge":95.81,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617510","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617510","type":"NDC"}],"standard_charges":[{"gross_charge":94.53,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641624725","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641624725","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703011301","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00703011301","type":"NDC"}],"standard_charges":[{"gross_charge":157.29,"discounted_cash":55.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703011303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00703011303","type":"NDC"}],"standard_charges":[{"gross_charge":136.21,"discounted_cash":47.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00703024301","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00703024301","type":"NDC"}],"standard_charges":[{"gross_charge":97.01,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML)","drug_information":{"unit":16.7,"type":"ML"},"code_information":[{"code":"Rx00703321601","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"00703321601","type":"NDC"}],"standard_charges":[{"gross_charge":336.33,"discounted_cash":117.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703367101","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367101","type":"NDC"}],"standard_charges":[{"gross_charge":286.65,"discounted_cash":100.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 250 MG/10ML (25 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703367501","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367501","type":"NDC"}],"standard_charges":[{"gross_charge":264.21,"discounted_cash":92.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00703367801","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367801","type":"NDC"}],"standard_charges":[{"gross_charge":358.86,"discounted_cash":125.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703424401","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"00703424401","type":"NDC"}],"standard_charges":[{"gross_charge":285.66,"discounted_cash":99.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRINOTECAN HCL INJ 40 MG/2ML (20 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703443211","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00703443211","type":"NDC"}],"standard_charges":[{"gross_charge":224.95,"discounted_cash":78.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703450201","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00703450201","type":"NDC"}],"standard_charges":[{"gross_charge":95.73,"discounted_cash":33.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703514501","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00703514501","type":"NDC"}],"standard_charges":[{"gross_charge":304.39,"discounted_cash":106.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DAUNORUBICIN HCL IV SOLN 20 MG/4ML (BASE EQUIV)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00703523313","type":"CDM"},{"code":"J9150","type":"HCPCS"},{"code":"00703523313","type":"NDC"}],"standard_charges":[{"gross_charge":1369.5,"discounted_cash":479.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00703574811","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"00703574811","type":"NDC"}],"standard_charges":[{"gross_charge":379.2,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703577801","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00703577801","type":"NDC"}],"standard_charges":[{"gross_charge":454.91,"discounted_cash":159.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00703856021","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00703856021","type":"NDC"}],"standard_charges":[{"gross_charge":99.65,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00703861021","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00703861021","type":"NDC"}],"standard_charges":[{"gross_charge":131.41,"discounted_cash":45.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00703877601","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00703877601","type":"NDC"}],"standard_charges":[{"gross_charge":889.72,"discounted_cash":311.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00703877701","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"00703877701","type":"NDC"}],"standard_charges":[{"gross_charge":1311.07,"discounted_cash":458.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703903201","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"00703903201","type":"NDC"}],"standard_charges":[{"gross_charge":96.8,"discounted_cash":33.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703951401","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"00703951401","type":"NDC"}],"standard_charges":[{"gross_charge":99.97,"discounted_cash":34.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013212","type":"CDM"},{"code":"00713013212","type":"NDC"}],"standard_charges":[{"gross_charge":36.89,"discounted_cash":12.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013512","type":"CDM"},{"code":"00713013512","type":"NDC"}],"standard_charges":[{"gross_charge":11.98,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINOLONE ACETONIDE CREAM 0.01%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713022315","type":"CDM"},{"code":"00713022315","type":"NDC"}],"standard_charges":[{"gross_charge":52.22,"discounted_cash":18.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINOLONE ACETONIDE OINT 0.025%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713022415","type":"CDM"},{"code":"00713022415","type":"NDC"}],"standard_charges":[{"gross_charge":39.46,"discounted_cash":13.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINOLONE ACETONIDE OINT 0.025%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00713022460","type":"CDM"},{"code":"00713022460","type":"NDC"}],"standard_charges":[{"gross_charge":117.9,"discounted_cash":41.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713052612","type":"CDM"},{"code":"00713052612","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713053612","type":"CDM"},{"code":"00713053612","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx00713057571","type":"CDM"},{"code":"00713057571","type":"NDC"}],"standard_charges":[{"gross_charge":103.11,"discounted_cash":36.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713068315","type":"CDM"},{"code":"00713068315","type":"NDC"}],"standard_charges":[{"gross_charge":17.52,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713068615","type":"CDM"},{"code":"00713068615","type":"NDC"}],"standard_charges":[{"gross_charge":4.27,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PERPHENAZINE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781104713","type":"CDM"},{"code":"Q0175","type":"HCPCS"},{"code":"00781104713","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781107901","type":"CDM"},{"code":"00781107901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781145201","type":"CDM"},{"code":"00781145201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781149669","type":"CDM"},{"code":"00781149669","type":"NDC"}],"standard_charges":[{"gross_charge":4.74,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781163501","type":"CDM"},{"code":"00781163501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781165501","type":"CDM"},{"code":"00781165501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781169501","type":"CDM"},{"code":"00781169501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781176413","type":"CDM"},{"code":"00781176413","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 250-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781187431","type":"CDM"},{"code":"00781187431","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781196260","type":"CDM"},{"code":"00781196260","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781196610","type":"CDM"},{"code":"00781196610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781202001","type":"CDM"},{"code":"00781202001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781202005","type":"CDM"},{"code":"00781202005","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781205101","type":"CDM"},{"code":"00781205101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781206701","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00781206701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781208102","type":"CDM"},{"code":"00781208102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781210301","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00781210301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781210401","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00781210401","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781214501","type":"CDM"},{"code":"00781214501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781225801","type":"CDM"},{"code":"00781225801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE IV SOLN 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781304072","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00781304072","type":"NDC"}],"standard_charges":[{"gross_charge":309.05,"discounted_cash":108.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE IV SOLN 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781304095","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00781304095","type":"NDC"}],"standard_charges":[{"gross_charge":309.16,"discounted_cash":108.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781305972","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00781305972","type":"NDC"}],"standard_charges":[{"gross_charge":98.07,"discounted_cash":34.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781309985","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781309985","type":"NDC"}],"standard_charges":[{"gross_charge":138.99,"discounted_cash":48.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781312485","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781312485","type":"NDC"}],"standard_charges":[{"gross_charge":98.82,"discounted_cash":34.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781312495","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781312495","type":"NDC"}],"standard_charges":[{"gross_charge":98.82,"discounted_cash":34.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781312585","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781312585","type":"NDC"}],"standard_charges":[{"gross_charge":235.23,"discounted_cash":82.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781312595","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781312595","type":"NDC"}],"standard_charges":[{"gross_charge":235.23,"discounted_cash":82.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00781315606","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"00781315606","type":"NDC"}],"standard_charges":[{"gross_charge":99.36,"discounted_cash":34.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781315895","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"00781315895","type":"NDC"}],"standard_charges":[{"gross_charge":770.2,"discounted_cash":269.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781315972","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00781315972","type":"NDC"}],"standard_charges":[{"gross_charge":164.08,"discounted_cash":57.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320785","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320785","type":"NDC"}],"standard_charges":[{"gross_charge":95.06,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320885","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320885","type":"NDC"}],"standard_charges":[{"gross_charge":94.86,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781322464","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781322464","type":"NDC"}],"standard_charges":[{"gross_charge":183.55,"discounted_cash":64.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00781323863","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781323863","type":"NDC"}],"standard_charges":[{"gross_charge":95.08,"discounted_cash":33.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781324664","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781324664","type":"NDC"}],"standard_charges":[{"gross_charge":95.22,"discounted_cash":33.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781325666","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781325666","type":"NDC"}],"standard_charges":[{"gross_charge":96.3,"discounted_cash":33.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00781326268","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326268","type":"NDC"}],"standard_charges":[{"gross_charge":97.66,"discounted_cash":34.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00781326869","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326869","type":"NDC"}],"standard_charges":[{"gross_charge":99.43,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328909","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328909","type":"NDC"}],"standard_charges":[{"gross_charge":248.4,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781329091","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781329091","type":"NDC"}],"standard_charges":[{"gross_charge":246.65,"discounted_cash":86.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00781329868","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329868","type":"NDC"}],"standard_charges":[{"gross_charge":100.56,"discounted_cash":35.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340078","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340078","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340095","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340095","type":"NDC"}],"standard_charges":[{"gross_charge":95.56,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340295","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340295","type":"NDC"}],"standard_charges":[{"gross_charge":93.84,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340485","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340485","type":"NDC"}],"standard_charges":[{"gross_charge":94.64,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340495","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340495","type":"NDC"}],"standard_charges":[{"gross_charge":94.67,"discounted_cash":33.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340778","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340778","type":"NDC"}],"standard_charges":[{"gross_charge":93.96,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340795","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340795","type":"NDC"}],"standard_charges":[{"gross_charge":93.97,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781344071","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"00781344071","type":"NDC"}],"standard_charges":[{"gross_charge":183.13,"discounted_cash":64.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781344095","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"00781344095","type":"NDC"}],"standard_charges":[{"gross_charge":333.74,"discounted_cash":116.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781345070","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00781345070","type":"NDC"}],"standard_charges":[{"gross_charge":95.18,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00781375575","type":"CDM"},{"code":"00781375575","type":"NDC"}],"standard_charges":[{"gross_charge":99.37,"discounted_cash":34.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00781375595","type":"CDM"},{"code":"00781375595","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781522010","type":"CDM"},{"code":"00781522010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523906","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00781523906","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523964","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00781523964","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781540601","type":"CDM"},{"code":"00781540601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781540964","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00781540964","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781560731","type":"CDM"},{"code":"00781560731","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLARITHROMYCIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781602346","type":"CDM"},{"code":"00781602346","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604155","type":"CDM"},{"code":"00781604155","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781613954","type":"CDM"},{"code":"00781613954","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G SODIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781615394","type":"CDM"},{"code":"00781615394","type":"NDC"}],"standard_charges":[{"gross_charge":402.56,"discounted_cash":140.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G SODIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781615395","type":"CDM"},{"code":"00781615395","type":"NDC"}],"standard_charges":[{"gross_charge":402.68,"discounted_cash":140.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781615746","type":"CDM"},{"code":"00781615746","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE OTIC SUSP 0.3-0.1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00781618667","type":"CDM"},{"code":"00781618667","type":"NDC"}],"standard_charges":[{"gross_charge":312.73,"discounted_cash":109.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781724055","type":"CDM"},{"code":"00781724055","type":"NDC"}],"standard_charges":[{"gross_charge":22.68,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781808931","type":"CDM"},{"code":"00781808931","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781910985","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781910985","type":"NDC"}],"standard_charges":[{"gross_charge":138.99,"discounted_cash":48.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781911188","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781911188","type":"NDC"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":71.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781911195","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"00781911195","type":"NDC"}],"standard_charges":[{"gross_charge":237.36,"discounted_cash":83.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781912485","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781912485","type":"NDC"}],"standard_charges":[{"gross_charge":120.88,"discounted_cash":42.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940178","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940178","type":"NDC"}],"standard_charges":[{"gross_charge":98.47,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832030200","type":"CDM"},{"code":"00832030200","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832035711","type":"CDM"},{"code":"00832035711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00832046515","type":"CDM"},{"code":"00832046515","type":"NDC"}],"standard_charges":[{"gross_charge":14.98,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00832046530","type":"CDM"},{"code":"00832046530","type":"NDC"}],"standard_charges":[{"gross_charge":29.34,"discounted_cash":10.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051101","type":"CDM"},{"code":"00832051101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051189","type":"CDM"},{"code":"00832051189","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051200","type":"CDM"},{"code":"00832051200","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051201","type":"CDM"},{"code":"00832051201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051289","type":"CDM"},{"code":"00832051289","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOBAZAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832058011","type":"CDM"},{"code":"00832058011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832101500","type":"CDM"},{"code":"00832101500","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832102400","type":"CDM"},{"code":"00832102400","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832102500","type":"CDM"},{"code":"00832102500","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121101","type":"CDM"},{"code":"00832121101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121189","type":"CDM"},{"code":"00832121189","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121200","type":"CDM"},{"code":"00832121200","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121201","type":"CDM"},{"code":"00832121201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121301","type":"CDM"},{"code":"00832121301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121389","type":"CDM"},{"code":"00832121389","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121601","type":"CDM"},{"code":"00832121601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832532511","type":"CDM"},{"code":"00832532511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832532515","type":"CDM"},{"code":"00832532515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832601700","type":"CDM"},{"code":"00832601700","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712401","type":"CDM"},{"code":"00832712401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712489","type":"CDM"},{"code":"00832712489","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904020161","type":"CDM"},{"code":"00904020161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904043004","type":"CDM"},{"code":"00904043004","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904043006","type":"CDM"},{"code":"00904043006","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN CAP ER 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904064352","type":"CDM"},{"code":"00904064352","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN CAP ER 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904064360","type":"CDM"},{"code":"00904064360","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904145361","type":"CDM"},{"code":"00904145361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904272561","type":"CDM"},{"code":"00904272561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904292061","type":"CDM"},{"code":"00904292061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904292461","type":"CDM"},{"code":"00904292461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904336561","type":"CDM"},{"code":"00904336561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904357161","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904357161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904385461","type":"CDM"},{"code":"00904385461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904504661","type":"CDM"},{"code":"00904504661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904522261","type":"CDM"},{"code":"00904522261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904528261","type":"CDM"},{"code":"00904528261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904539261","type":"CDM"},{"code":"00904539261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904544861","type":"CDM"},{"code":"00904544861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552261","type":"CDM"},{"code":"00904552261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552361","type":"CDM"},{"code":"00904552361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904565861","type":"CDM"},{"code":"00904565861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904567661","type":"CDM"},{"code":"00904567661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904567761","type":"CDM"},{"code":"00904567761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OMEPRAZOLE CAP DELAYED RELEASE 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904568461","type":"CDM"},{"code":"00904568461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578461","type":"CDM"},{"code":"00904578461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578561","type":"CDM"},{"code":"00904578561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578961","type":"CDM"},{"code":"00904578961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579061","type":"CDM"},{"code":"00904579061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904580861","type":"CDM"},{"code":"00904580861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904584061","type":"CDM"},{"code":"00904584061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585361","type":"CDM"},{"code":"00904585361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585461","type":"CDM"},{"code":"00904585461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585561","type":"CDM"},{"code":"00904585561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THEOPHYLLINE TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904588761","type":"CDM"},{"code":"00904588761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THEOPHYLLINE TAB ER 12HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904588961","type":"CDM"},{"code":"00904588961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589161","type":"CDM"},{"code":"00904589161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589261","type":"CDM"},{"code":"00904589261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589361","type":"CDM"},{"code":"00904589361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592161","type":"CDM"},{"code":"00904592161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592361","type":"CDM"},{"code":"00904592361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592561","type":"CDM"},{"code":"00904592561","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592861","type":"CDM"},{"code":"00904592861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904595961","type":"CDM"},{"code":"00904595961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904597361","type":"CDM"},{"code":"00904597361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904597561","type":"CDM"},{"code":"00904597561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904599161","type":"CDM"},{"code":"00904599161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904599361","type":"CDM"},{"code":"00904599361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904599661","type":"CDM"},{"code":"00904599661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600761","type":"CDM"},{"code":"00904600761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600861","type":"CDM"},{"code":"00904600861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600961","type":"CDM"},{"code":"00904600961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904605261","type":"CDM"},{"code":"00904605261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904606961","type":"CDM"},{"code":"00904606961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608261","type":"CDM"},{"code":"00904608261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608361","type":"CDM"},{"code":"00904608361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608461","type":"CDM"},{"code":"00904608461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608561","type":"CDM"},{"code":"00904608561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904609161","type":"CDM"},{"code":"00904609161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904612161","type":"CDM"},{"code":"00904612161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904617261","type":"CDM"},{"code":"00904617261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904619361","type":"CDM"},{"code":"00904619361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904623861","type":"CDM"},{"code":"00904623861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904624661","type":"CDM"},{"code":"00904624661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904624861","type":"CDM"},{"code":"00904624861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904624961","type":"CDM"},{"code":"00904624961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904625061","type":"CDM"},{"code":"00904625061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904625161","type":"CDM"},{"code":"00904625161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904626908","type":"CDM"},{"code":"00904626908","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627208","type":"CDM"},{"code":"00904627208","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628361","type":"CDM"},{"code":"00904628361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629061","type":"CDM"},{"code":"00904629061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629161","type":"CDM"},{"code":"00904629161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629206","type":"CDM"},{"code":"00904629206","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629261","type":"CDM"},{"code":"00904629261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629304","type":"CDM"},{"code":"00904629304","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629461","type":"CDM"},{"code":"00904629461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630061","type":"CDM"},{"code":"00904630061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630161","type":"CDM"},{"code":"00904630161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630261","type":"CDM"},{"code":"00904630261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630361","type":"CDM"},{"code":"00904630361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904631561","type":"CDM"},{"code":"00904631561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632206","type":"CDM"},{"code":"00904632206","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632261","type":"CDM"},{"code":"00904632261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632361","type":"CDM"},{"code":"00904632361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632461","type":"CDM"},{"code":"00904632461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632661","type":"CDM"},{"code":"00904632661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635161","type":"CDM"},{"code":"00904635161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635261","type":"CDM"},{"code":"00904635261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635361","type":"CDM"},{"code":"00904635361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635761","type":"CDM"},{"code":"00904635761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635861","type":"CDM"},{"code":"00904635861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636345","type":"CDM"},{"code":"00904636345","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636361","type":"CDM"},{"code":"00904636361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636961","type":"CDM"},{"code":"00904636961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637061","type":"CDM"},{"code":"00904637061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637161","type":"CDM"},{"code":"00904637161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637361","type":"CDM"},{"code":"00904637361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637461","type":"CDM"},{"code":"00904637461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637661","type":"CDM"},{"code":"00904637661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637761","type":"CDM"},{"code":"00904637761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640506","type":"CDM"},{"code":"00904640506","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904641861","type":"CDM"},{"code":"00904641861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642404","type":"CDM"},{"code":"00904642404","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642661","type":"CDM"},{"code":"00904642661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642761","type":"CDM"},{"code":"00904642761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904643604","type":"CDM"},{"code":"00904643604","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644961","type":"CDM"},{"code":"00904644961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645061","type":"CDM"},{"code":"00904645061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646161","type":"CDM"},{"code":"00904646161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646707","type":"CDM"},{"code":"00904646707","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":5.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647461","type":"CDM"},{"code":"00904647461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647561","type":"CDM"},{"code":"00904647561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647661","type":"CDM"},{"code":"00904647661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647761","type":"CDM"},{"code":"00904647761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647861","type":"CDM"},{"code":"00904647861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650006","type":"CDM"},{"code":"00904650006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650061","type":"CDM"},{"code":"00904650061","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650161","type":"CDM"},{"code":"00904650161","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650261","type":"CDM"},{"code":"00904650261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650361","type":"CDM"},{"code":"00904650361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650561","type":"CDM"},{"code":"00904650561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650661","type":"CDM"},{"code":"00904650661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651961","type":"CDM"},{"code":"00904651961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904653061","type":"CDM"},{"code":"00904653061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655061","type":"CDM"},{"code":"00904655061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655304","type":"CDM"},{"code":"00904655304","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655761","type":"CDM"},{"code":"00904655761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655861","type":"CDM"},{"code":"00904655861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656460","type":"CDM"},{"code":"00904656460","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656507","type":"CDM"},{"code":"00904656507","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656561","type":"CDM"},{"code":"00904656561","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657061","type":"CDM"},{"code":"00904657061","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657261","type":"CDM"},{"code":"00904657261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904661561","type":"CDM"},{"code":"00904661561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904661761","type":"CDM"},{"code":"00904661761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904661961","type":"CDM"},{"code":"00904661961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662061","type":"CDM"},{"code":"00904662061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662261","type":"CDM"},{"code":"00904662261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662361","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00904662361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663561","type":"CDM"},{"code":"00904663561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663661","type":"CDM"},{"code":"00904663661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663761","type":"CDM"},{"code":"00904663761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663861","type":"CDM"},{"code":"00904663861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663961","type":"CDM"},{"code":"00904663961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664161","type":"CDM"},{"code":"00904664161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666361","type":"CDM"},{"code":"00904666361","type":"NDC"}],"standard_charges":[{"gross_charge":4.09,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666561","type":"CDM"},{"code":"00904666561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666661","type":"CDM"},{"code":"00904666661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666761","type":"CDM"},{"code":"00904666761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904667106","type":"CDM"},{"code":"00904667106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670310","type":"CDM"},{"code":"00904670310","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670461","type":"CDM"},{"code":"00904670461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670806","type":"CDM"},{"code":"00904670806","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670961","type":"CDM"},{"code":"00904670961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COLCHICINE CAP 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904673204","type":"CDM"},{"code":"00904673204","type":"NDC"}],"standard_charges":[{"gross_charge":7.24,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678261","type":"CDM"},{"code":"00904678261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679061","type":"CDM"},{"code":"00904679061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679104","type":"CDM"},{"code":"00904679104","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679761","type":"CDM"},{"code":"00904679761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679861","type":"CDM"},{"code":"00904679861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679961","type":"CDM"},{"code":"00904679961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904680861","type":"CDM"},{"code":"00904680861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681706","type":"CDM"},{"code":"00904681706","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681806","type":"CDM"},{"code":"00904681806","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681861","type":"CDM"},{"code":"00904681861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682207","type":"CDM"},{"code":"00904682207","type":"NDC"}],"standard_charges":[{"gross_charge":5.19,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682661","type":"CDM"},{"code":"00904682661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904682892","type":"CDM"},{"code":"00904682892","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904682894","type":"CDM"},{"code":"00904682894","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904683006","type":"CDM"},{"code":"00904683006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904683061","type":"CDM"},{"code":"00904683061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686061","type":"CDM"},{"code":"00904686061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686161","type":"CDM"},{"code":"00904686161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686861","type":"CDM"},{"code":"00904686861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686961","type":"CDM"},{"code":"00904686961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904687045","type":"CDM"},{"code":"00904687045","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689004","type":"CDM"},{"code":"00904689004","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904690004","type":"CDM"},{"code":"00904690004","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904691461","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"00904691461","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OMEPRAZOLE CAP DELAYED RELEASE 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904691761","type":"CDM"},{"code":"00904691761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692461","type":"CDM"},{"code":"00904692461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692761","type":"CDM"},{"code":"00904692761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693961","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904693961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904694961","type":"CDM"},{"code":"00904694961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695061","type":"CDM"},{"code":"00904695061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695161","type":"CDM"},{"code":"00904695161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695261","type":"CDM"},{"code":"00904695261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695361","type":"CDM"},{"code":"00904695361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695461","type":"CDM"},{"code":"00904695461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695561","type":"CDM"},{"code":"00904695561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904696661","type":"CDM"},{"code":"00904696661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904698761","type":"CDM"},{"code":"00904698761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699161","type":"CDM"},{"code":"00904699161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699261","type":"CDM"},{"code":"00904699261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699361","type":"CDM"},{"code":"00904699361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700061","type":"CDM"},{"code":"00904700061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700761","type":"CDM"},{"code":"00904700761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700861","type":"CDM"},{"code":"00904700861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904701604","type":"CDM"},{"code":"00904701604","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904701661","type":"CDM"},{"code":"00904701661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702061","type":"CDM"},{"code":"00904702061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702561","type":"CDM"},{"code":"00904702561","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702761","type":"CDM"},{"code":"00904702761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904703580","type":"CDM"},{"code":"00904703580","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904703588","type":"CDM"},{"code":"00904703588","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704261","type":"CDM"},{"code":"00904704261","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704561","type":"CDM"},{"code":"00904704561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704661","type":"CDM"},{"code":"00904704661","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704861","type":"CDM"},{"code":"00904704861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705261","type":"CDM"},{"code":"00904705261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705361","type":"CDM"},{"code":"00904705361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705761","type":"CDM"},{"code":"00904705761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904706094","type":"CDM"},{"code":"00904706094","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904706561","type":"CDM"},{"code":"00904706561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707007","type":"CDM"},{"code":"00904707007","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707561","type":"CDM"},{"code":"00904707561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707661","type":"CDM"},{"code":"00904707661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00904707924","type":"CDM"},{"code":"00904707924","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708106","type":"CDM"},{"code":"00904708106","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708206","type":"CDM"},{"code":"00904708206","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708361","type":"CDM"},{"code":"00904708361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708461","type":"CDM"},{"code":"00904708461","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708761","type":"CDM"},{"code":"00904708761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOZAPINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708961","type":"CDM"},{"code":"00904708961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904709761","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00904709761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710561","type":"CDM"},{"code":"00904710561","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710961","type":"CDM"},{"code":"00904710961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711906","type":"CDM"},{"code":"00904711906","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712161","type":"CDM"},{"code":"00904712161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712261","type":"CDM"},{"code":"00904712261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712461","type":"CDM"},{"code":"00904712461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712561","type":"CDM"},{"code":"00904712561","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712661","type":"CDM"},{"code":"00904712661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712804","type":"CDM"},{"code":"00904712804","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904713006","type":"CDM"},{"code":"00904713006","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904713761","type":"CDM"},{"code":"00904713761","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714004","type":"CDM"},{"code":"00904714004","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714110","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"00904714110","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715361","type":"CDM"},{"code":"00904715361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715661","type":"CDM"},{"code":"00904715661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715761","type":"CDM"},{"code":"00904715761","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904716261","type":"CDM"},{"code":"00904716261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904716361","type":"CDM"},{"code":"00904716361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904716461","type":"CDM"},{"code":"00904716461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717761","type":"CDM"},{"code":"00904717761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717861","type":"CDM"},{"code":"00904717861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717961","type":"CDM"},{"code":"00904717961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718761","type":"CDM"},{"code":"00904718761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719461","type":"CDM"},{"code":"00904719461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904720061","type":"CDM"},{"code":"00904720061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721104","type":"CDM"},{"code":"00904721104","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE TAB ER 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721661","type":"CDM"},{"code":"00904721661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722961","type":"CDM"},{"code":"00904722961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904723661","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904723661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904724468","type":"CDM"},{"code":"00904724468","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904725761","type":"CDM"},{"code":"00904725761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726261","type":"CDM"},{"code":"00904726261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726361","type":"CDM"},{"code":"00904726361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904726592","type":"CDM"},{"code":"00904726592","type":"NDC"}],"standard_charges":[{"gross_charge":4.11,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904727061","type":"CDM"},{"code":"00904727061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727670","type":"CDM"},{"code":"00904727670","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904728961","type":"CDM"},{"code":"00904728961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730461","type":"CDM"},{"code":"00904730461","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904734661","type":"CDM"},{"code":"00904734661","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LURASIDONE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904735504","type":"CDM"},{"code":"00904735504","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736161","type":"CDM"},{"code":"00904736161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736261","type":"CDM"},{"code":"00904736261","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736806","type":"CDM"},{"code":"00904736806","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904738361","type":"CDM"},{"code":"00904738361","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904739061","type":"CDM"},{"code":"00904739061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904741161","type":"CDM"},{"code":"00904741161","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904741761","type":"CDM"},{"code":"00904741761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750561","type":"CDM"},{"code":"00904750561","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904771861","type":"CDM"},{"code":"00904771861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904772861","type":"CDM"},{"code":"00904772861","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904780961","type":"CDM"},{"code":"00904780961","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHYL ESTERS OF IODIZED FATTY ACIDS INJECTION","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00930621608","type":"CDM"},{"code":"00930621608","type":"NDC"}],"standard_charges":[{"gross_charge":1225.28,"discounted_cash":428.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PERITONEAL DIALYSIS SOLUTIONS 396 MOSM/L","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00941042752","type":"CDM"},{"code":"00941042752","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTICOAGULANT CITRATE DEXTROSE SOLUTION A","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00942064103","type":"CDM"},{"code":"00942064103","type":"NDC"}],"standard_charges":[{"gross_charge":99.83,"discounted_cash":34.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTICOAGULANT CITRATE DEXTROSE SOLUTION A","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00942064104","type":"CDM"},{"code":"00942064104","type":"NDC"}],"standard_charges":[{"gross_charge":100.52,"discounted_cash":35.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944049301","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"00944049301","type":"NDC"}],"standard_charges":[{"gross_charge":346.08,"discounted_cash":121.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944049302","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"00944049302","type":"NDC"}],"standard_charges":[{"gross_charge":346.08,"discounted_cash":121.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944049304","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"00944049304","type":"NDC"}],"standard_charges":[{"gross_charge":346.08,"discounted_cash":121.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00944049505","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"00944049505","type":"NDC"}],"standard_charges":[{"gross_charge":347.2,"discounted_cash":121.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00944049506","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"00944049506","type":"NDC"}],"standard_charges":[{"gross_charge":338.8,"discounted_cash":118.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944270004","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"gross_charge":4012.4,"discounted_cash":1404.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00944270005","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005","type":"NDC"}],"standard_charges":[{"gross_charge":8024.8,"discounted_cash":2808.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00944270006","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006","type":"NDC"}],"standard_charges":[{"gross_charge":16049.6,"discounted_cash":5617.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 1500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944294410","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00944294410","type":"NDC"}],"standard_charges":[{"gross_charge":94.37,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 1500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944305402","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00944305402","type":"NDC"}],"standard_charges":[{"gross_charge":21340.36,"discounted_cash":7469.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00955102001","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00955102001","type":"NDC"}],"standard_charges":[{"gross_charge":496.49,"discounted_cash":173.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00955102104","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00955102104","type":"NDC"}],"standard_charges":[{"gross_charge":1513.75,"discounted_cash":529.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00990707426","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990707426","type":"NDC"}],"standard_charges":[{"gross_charge":245.1,"discounted_cash":85.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00990707514","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990707514","type":"NDC"}],"standard_charges":[{"gross_charge":245.5,"discounted_cash":85.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00990707526","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990707526","type":"NDC"}],"standard_charges":[{"gross_charge":245.1,"discounted_cash":85.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00990707714","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990707714","type":"NDC"}],"standard_charges":[{"gross_charge":245.3,"discounted_cash":85.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00990771502","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00990771502","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00990771503","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00990771503","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00990793003","type":"CDM"},{"code":"00990793003","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 20%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00990793519","type":"CDM"},{"code":"00990793519","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00990798502","type":"CDM"},{"code":"00990798502","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00990925739","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990925739","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020615","type":"CDM"},{"code":"00998020615","type":"NDC"}],"standard_charges":[{"gross_charge":138.19,"discounted_cash":48.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXIDIZED CELLULOSE PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx05031000303","type":"CDM"},{"code":"05031000303","type":"NDC"}],"standard_charges":[{"gross_charge":61.29,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 8.5 MG/0.85ML","drug_information":{"unit":0.85,"type":"ML"},"code_information":[{"code":"Rx08065183085","type":"CDM"},{"code":"08065183085","type":"NDC"}],"standard_charges":[{"gross_charge":679.05,"discounted_cash":237.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NA HYALURON & NA HYALURON-NA CHONDROIT SUL OP KIT 0.55-0.5ML","drug_information":{"unit":1.05,"type":"ML"},"code_information":[{"code":"Rx08065183150","type":"CDM"},{"code":"08065183150","type":"NDC"}],"standard_charges":[{"gross_charge":920.97,"discounted_cash":322.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NA CHONDROIT SULF-NA HYALURON PREF SYR 20-15 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx08065183905","type":"CDM"},{"code":"08065183905","type":"NDC"}],"standard_charges":[{"gross_charge":690.48,"discounted_cash":241.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 13.8 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx08544508321","type":"CDM"},{"code":"08544508321","type":"NDC"}],"standard_charges":[{"gross_charge":1293.6,"discounted_cash":452.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx10019005561","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"10019005561","type":"NDC"}],"standard_charges":[{"gross_charge":585.8,"discounted_cash":205.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx10019012001","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"10019012001","type":"NDC"}],"standard_charges":[{"gross_charge":121.18,"discounted_cash":42.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092501","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092501","type":"NDC"}],"standard_charges":[{"gross_charge":488.69,"discounted_cash":171.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092602","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092602","type":"NDC"}],"standard_charges":[{"gross_charge":1118.23,"discounted_cash":391.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PORACTANT ALFA INTRATRACHEAL SUSP 240 MG/3ML,PORACTANT ALFA INTRATRACHEAL SUSP 120 MG/1.5ML","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx10122051001","type":"CDM"},{"code":"10122051001","type":"NDC"}],"standard_charges":[{"gross_charge":6138.6,"discounted_cash":2148.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PORACTANT ALFA INTRATRACHEAL SUSP 240 MG/3ML,PORACTANT ALFA INTRATRACHEAL SUSP 120 MG/1.5ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx10122051003","type":"CDM"},{"code":"10122051003","type":"NDC"}],"standard_charges":[{"gross_charge":11946.81,"discounted_cash":4181.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CANGRELOR TETRASODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10122062001","type":"CDM"},{"code":"C9460","type":"HCPCS"},{"code":"10122062001","type":"NDC"}],"standard_charges":[{"gross_charge":7812.54,"discounted_cash":2734.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CANGRELOR TETRASODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10122062010","type":"CDM"},{"code":"C9460","type":"HCPCS"},{"code":"10122062010","type":"NDC"}],"standard_charges":[{"gross_charge":10261.04,"discounted_cash":3591.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10147088106","type":"CDM"},{"code":"10147088106","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx10147091101","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"10147091101","type":"NDC"}],"standard_charges":[{"gross_charge":98.42,"discounted_cash":34.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ITRACONAZOLE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10147170003","type":"CDM"},{"code":"10147170003","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ITRACONAZOLE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10147170007","type":"CDM"},{"code":"10147170007","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTAMBEN-TETRACAINE-BENZOCAINE AEROSOL SPRAY 2-2-14%","drug_information":{"unit":56.0,"type":"GM"},"code_information":[{"code":"Rx10223020101","type":"CDM"},{"code":"10223020101","type":"NDC"}],"standard_charges":[{"gross_charge":58.96,"discounted_cash":20.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTAMBEN-TETRACAINE-BENZOCAINE AEROSOL SPRAY 2-2-14%","drug_information":{"unit":20.0,"type":"GM"},"code_information":[{"code":"Rx10223020103","type":"CDM"},{"code":"10223020103","type":"NDC"}],"standard_charges":[{"gross_charge":183.6,"discounted_cash":64.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTAMBEN-TETRACAINE-BENZOCAINE AEROSOL SPRAY 2-2-14%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx10223020104","type":"CDM"},{"code":"10223020104","type":"NDC"}],"standard_charges":[{"gross_charge":84.28,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10370010103","type":"CDM"},{"code":"10370010103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10370083009","type":"CDM"},{"code":"10370083009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10542001010","type":"CDM"},{"code":"10542001010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENTERMINE HCL CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702002801","type":"CDM"},{"code":"10702002801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE POWDER","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx10702003645","type":"CDM"},{"code":"10702003645","type":"NDC"}],"standard_charges":[{"gross_charge":95.34,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702010101","type":"CDM"},{"code":"10702010101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE POWDER","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx11534016644","type":"CDM"},{"code":"11534016644","type":"NDC"}],"standard_charges":[{"gross_charge":61.29,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 0.12%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980017405","type":"CDM"},{"code":"11980017405","type":"NDC"}],"standard_charges":[{"gross_charge":220.6,"discounted_cash":77.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PERFLUTREN LIPID MICROSPHERE IV SUSP 6.52 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx11994001104","type":"CDM"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001104","type":"NDC"}],"standard_charges":[{"gross_charge":319.5,"discounted_cash":111.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SAMARIUM SM 153 LEXIDRONAM INJ 1850 MBQ/ML (50 MCI/ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11994001601","type":"CDM"},{"code":"A9604","type":"HCPCS"},{"code":"11994001601","type":"NDC"}],"standard_charges":[{"gross_charge":60668.0,"discounted_cash":21233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12870000101","type":"CDM"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12870000102","type":"CDM"},{"code":"12870000102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13107003134","type":"CDM"},{"code":"13107003134","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 2-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx13533013101","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"13533013101","type":"NDC"}],"standard_charges":[{"gross_charge":242.7,"discounted_cash":84.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNT/5ML (300 UNT/ML),RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 900 UNT/3ML (300 UNT/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533031801","type":"CDM"},{"code":"90375","type":"HCPCS"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"gross_charge":4995.42,"discounted_cash":1748.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IM SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx13533033504","type":"CDM"},{"code":"J1460","type":"HCPCS"},{"code":"13533033504","type":"NDC"}],"standard_charges":[{"gross_charge":1085.61,"discounted_cash":379.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETANUS IMMUNE GLOBULIN (HUMAN) IM SOLN PREF SYR 250 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533063402","type":"CDM"},{"code":"J1670","type":"HCPCS"},{"code":"13533063402","type":"NDC"}],"standard_charges":[{"gross_charge":5852.44,"discounted_cash":2048.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B IMMUN GLOB (HUMAN) IM SOLN PREF SYR 220 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533063602","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063602","type":"NDC"}],"standard_charges":[{"gross_charge":1603.84,"discounted_cash":561.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B IMMUN GLOB (HUMAN) IM SOLN PREF SYR 110 UT/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx13533063603","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063603","type":"NDC"}],"standard_charges":[{"gross_charge":864.75,"discounted_cash":302.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 220 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx13533063605","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063605","type":"NDC"}],"standard_charges":[{"gross_charge":7468.72,"discounted_cash":2614.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B IMMUN GLOB (HUMAN) IM SOLN PREF SYR 110 UT/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx13533063630","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063630","type":"NDC"}],"standard_charges":[{"gross_charge":864.75,"discounted_cash":302.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 220 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx13533063650","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063650","type":"NDC"}],"standard_charges":[{"gross_charge":7468.72,"discounted_cash":2614.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx13533068525","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"13533068525","type":"NDC"}],"standard_charges":[{"gross_charge":394.8,"discounted_cash":138.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx13533080024","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"gross_charge":14580.16,"discounted_cash":5103.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668000701","type":"CDM"},{"code":"13668000701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009290","type":"CDM"},{"code":"13668009290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009390","type":"CDM"},{"code":"13668009390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668011310","type":"CDM"},{"code":"13668011310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668013201","type":"CDM"},{"code":"13668013201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668013301","type":"CDM"},{"code":"13668013301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668021730","type":"CDM"},{"code":"13668021730","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668021830","type":"CDM"},{"code":"13668021830","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANAGRELIDE HCL CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668045301","type":"CDM"},{"code":"13668045301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ITRACONAZOLE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668046330","type":"CDM"},{"code":"13668046330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811068030","type":"CDM"},{"code":"13811068030","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx14789010705","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010705","type":"NDC"}],"standard_charges":[{"gross_charge":252.88,"discounted_cash":88.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789010910","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010910","type":"NDC"}],"standard_charges":[{"gross_charge":372.36,"discounted_cash":130.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx14789012105","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"14789012105","type":"NDC"}],"standard_charges":[{"gross_charge":100.58,"discounted_cash":35.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LANREOTIDE ACETATE EXTENDED RELEASE INJ 60 MG/0.2ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx15054106004","type":"CDM"},{"code":"J1930","type":"HCPCS"},{"code":"15054106004","type":"NDC"}],"standard_charges":[{"gross_charge":70563.8,"discounted_cash":24697.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571012706","type":"CDM"},{"code":"16571012706","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL ELIXIR 20 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx16571033016","type":"CDM"},{"code":"16571033016","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL TAB 64.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571066701","type":"CDM"},{"code":"16571066701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL TAB 97.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571066801","type":"CDM"},{"code":"16571066801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571067642","type":"CDM"},{"code":"16571067642","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571073521","type":"CDM"},{"code":"16571073521","type":"NDC"}],"standard_charges":[{"gross_charge":17.98,"discounted_cash":6.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571073528","type":"CDM"},{"code":"16571073528","type":"NDC"}],"standard_charges":[{"gross_charge":16.76,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATEGLINIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571075809","type":"CDM"},{"code":"16571075809","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571075909","type":"CDM"},{"code":"16571075909","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571078812","type":"CDM"},{"code":"16571078812","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571086203","type":"CDM"},{"code":"16571086203","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx16714009625","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"16714009625","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16714075301","type":"CDM"},{"code":"16714075301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729000101","type":"CDM"},{"code":"16729000101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002110","type":"CDM"},{"code":"16729002110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002115","type":"CDM"},{"code":"16729002115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002301","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729002301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002310","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729002310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729003515","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729003515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729004301","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"16729004301","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPECITABINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729007212","type":"CDM"},{"code":"J8522","type":"HCPCS"},{"code":"16729007212","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009203","type":"CDM"},{"code":"J9196","type":"HCPCS"},{"code":"16729009203","type":"NDC"}],"standard_charges":[{"gross_charge":285.81,"discounted_cash":100.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009401","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"16729009401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729010811","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729010811","type":"NDC"}],"standard_charges":[{"gross_charge":1279.42,"discounted_cash":447.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx16729011431","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":287.51,"discounted_cash":100.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOMYCIN FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729011505","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729011505","type":"NDC"}],"standard_charges":[{"gross_charge":768.93,"discounted_cash":269.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729011638","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729011638","type":"NDC"}],"standard_charges":[{"gross_charge":12985.37,"discounted_cash":4544.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729011711","type":"CDM"},{"code":"J9196","type":"HCPCS"},{"code":"16729011711","type":"NDC"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729013600","type":"CDM"},{"code":"16729013600","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729013700","type":"CDM"},{"code":"16729013700","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729017101","type":"CDM"},{"code":"16729017101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729018301","type":"CDM"},{"code":"16729018301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729020201","type":"CDM"},{"code":"16729020201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729021615","type":"CDM"},{"code":"16729021615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729026129","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"16729026129","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729027730","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"16729027730","type":"NDC"}],"standard_charges":[{"gross_charge":263.87,"discounted_cash":92.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx16729028811","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"16729028811","type":"NDC"}],"standard_charges":[{"gross_charge":243.6,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729041401","type":"CDM"},{"code":"16729041401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729044010","type":"CDM"},{"code":"16729044010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729044015","type":"CDM"},{"code":"16729044015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729044315","type":"CDM"},{"code":"16729044315","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729048601","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"16729048601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729050008","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"16729050008","type":"NDC"}],"standard_charges":[{"gross_charge":94.25,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090011","type":"CDM"},{"code":"17238090011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090030","type":"CDM"},{"code":"17238090030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090099","type":"CDM"},{"code":"17238090099","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478001202","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"17478001202","type":"NDC"}],"standard_charges":[{"gross_charge":170.73,"discounted_cash":59.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478004001","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"17478004001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETRACAINE HCL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478004532","type":"CDM"},{"code":"17478004532","type":"NDC"}],"standard_charges":[{"gross_charge":390.18,"discounted_cash":136.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx17478007031","type":"CDM"},{"code":"17478007031","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478010112","type":"CDM"},{"code":"17478010112","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478020020","type":"CDM"},{"code":"17478020020","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478020102","type":"CDM"},{"code":"17478020102","type":"NDC"}],"standard_charges":[{"gross_charge":44.73,"discounted_cash":15.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478020605","type":"CDM"},{"code":"17478020605","type":"NDC"}],"standard_charges":[{"gross_charge":55.05,"discounted_cash":19.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx17478020919","type":"CDM"},{"code":"17478020919","type":"NDC"}],"standard_charges":[{"gross_charge":20.26,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-BACITRAC ZN-POLYMYX 5(3.5)MG-400UNT-10000UNT OP OIN","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx17478023535","type":"CDM"},{"code":"17478023535","type":"NDC"}],"standard_charges":[{"gross_charge":61.26,"discounted_cash":21.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478029010","type":"CDM"},{"code":"17478029010","type":"NDC"}],"standard_charges":[{"gross_charge":16.14,"discounted_cash":5.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478040303","type":"CDM"},{"code":"17478040303","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478040401","type":"CDM"},{"code":"17478040401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYSOSTIGMINE SALICYLATE INJ 1 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx17478051002","type":"CDM"},{"code":"17478051002","type":"NDC"}],"standard_charges":[{"gross_charge":201.11,"discounted_cash":70.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478054202","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"17478054202","type":"NDC"}],"standard_charges":[{"gross_charge":98.71,"discounted_cash":34.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478070510","type":"CDM"},{"code":"17478070510","type":"NDC"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":24.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN-NEOMYCIN-HC OPHTH OINT 1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx17478071935","type":"CDM"},{"code":"17478071935","type":"NDC"}],"standard_charges":[{"gross_charge":68.38,"discounted_cash":23.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM OPHTH SOLN 0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx17478089225","type":"CDM"},{"code":"17478089225","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478093710","type":"CDM"},{"code":"17478093710","type":"NDC"}],"standard_charges":[{"gross_charge":93.72,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PERMETHRIN CREAM 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx21922002107","type":"CDM"},{"code":"21922002107","type":"NDC"}],"standard_charges":[{"gross_charge":27.63,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULINDAC TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155000501","type":"CDM"},{"code":"23155000501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETRACYCLINE HCL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155001701","type":"CDM"},{"code":"23155001701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155002301","type":"CDM"},{"code":"23155002301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155002401","type":"CDM"},{"code":"23155002401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155002601","type":"CDM"},{"code":"23155002601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155004403","type":"CDM"},{"code":"23155004403","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155004801","type":"CDM"},{"code":"23155004801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155005901","type":"CDM"},{"code":"23155005901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155006501","type":"CDM"},{"code":"23155006501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155007001","type":"CDM"},{"code":"23155007001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010205","type":"CDM"},{"code":"23155010205","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010301","type":"CDM"},{"code":"23155010301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010501","type":"CDM"},{"code":"23155010501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010811","type":"CDM"},{"code":"23155010811","type":"NDC"}],"standard_charges":[{"gross_charge":9.31,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010830","type":"CDM"},{"code":"23155010830","type":"NDC"}],"standard_charges":[{"gross_charge":8.14,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155011801","type":"CDM"},{"code":"23155011801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155011803","type":"CDM"},{"code":"23155011803","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155016631","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"23155016631","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":34.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155016641","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"23155016641","type":"NDC"}],"standard_charges":[{"gross_charge":95.53,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155019401","type":"CDM"},{"code":"23155019401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155022901","type":"CDM"},{"code":"23155022901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155024801","type":"CDM"},{"code":"23155024801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029041","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"gross_charge":95.42,"discounted_cash":33.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029431","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029431","type":"NDC"}],"standard_charges":[{"gross_charge":97.09,"discounted_cash":33.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029441","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029441","type":"NDC"}],"standard_charges":[{"gross_charge":97.9,"discounted_cash":34.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029442","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"gross_charge":96.12,"discounted_cash":33.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155031331","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"23155031331","type":"NDC"}],"standard_charges":[{"gross_charge":301.05,"discounted_cash":105.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155048601","type":"CDM"},{"code":"23155048601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155048901","type":"CDM"},{"code":"23155048901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155050001","type":"CDM"},{"code":"23155050001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155050101","type":"CDM"},{"code":"23155050101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155051200","type":"CDM"},{"code":"23155051200","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155051211","type":"CDM"},{"code":"23155051211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155053102","type":"CDM"},{"code":"23155053102","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155054731","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"23155054731","type":"NDC"}],"standard_charges":[{"gross_charge":94.11,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155057901","type":"CDM"},{"code":"23155057901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx23155060031","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"23155060031","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx23155060041","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"23155060041","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx23155060351","type":"CDM"},{"code":"23155060351","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155060503","type":"CDM"},{"code":"23155060503","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155060601","type":"CDM"},{"code":"23155060601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155065201","type":"CDM"},{"code":"23155065201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155066201","type":"CDM"},{"code":"23155066201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155066203","type":"CDM"},{"code":"23155066203","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155083301","type":"CDM"},{"code":"23155083301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155083401","type":"CDM"},{"code":"23155083401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155083730","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"23155083730","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155085878","type":"CDM"},{"code":"23155085878","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOBARBITAL SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24201001020","type":"CDM"},{"code":"J2515","type":"HCPCS"},{"code":"24201001020","type":"NDC"}],"standard_charges":[{"gross_charge":727.42,"discounted_cash":254.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOBARBITAL SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24201001050","type":"CDM"},{"code":"J2515","type":"HCPCS"},{"code":"24201001050","type":"NDC"}],"standard_charges":[{"gross_charge":479.66,"discounted_cash":167.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx24201010001","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"24201010001","type":"NDC"}],"standard_charges":[{"gross_charge":100.4,"discounted_cash":35.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITONIN (SALMON) INJ 200 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24201040002","type":"CDM"},{"code":"J0630","type":"HCPCS"},{"code":"24201040002","type":"NDC"}],"standard_charges":[{"gross_charge":5648.16,"discounted_cash":1976.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYALURONIDASE OVINE INJ 200 UNIT/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx24208000201","type":"CDM"},{"code":"J3471","type":"HCPCS"},{"code":"24208000201","type":"NDC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx24208029525","type":"CDM"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":70.54,"discounted_cash":24.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLURBIPROFEN SODIUM OPHTH SOLN 0.03%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx24208031425","type":"CDM"},{"code":"24208031425","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208031510","type":"CDM"},{"code":"24208031510","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.06% (42 MCG/SPRAY)","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx24208039915","type":"CDM"},{"code":"24208039915","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208043405","type":"CDM"},{"code":"24208043405","type":"NDC"}],"standard_charges":[{"gross_charge":28.51,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx24208046325","type":"CDM"},{"code":"24208046325","type":"NDC"}],"standard_charges":[{"gross_charge":25.65,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208048510","type":"CDM"},{"code":"24208048510","type":"NDC"}],"standard_charges":[{"gross_charge":47.41,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208048610","type":"CDM"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"gross_charge":12.88,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCHOLINE CHLORIDE INTRAOCULAR FOR SOLN 20 MG (1:100)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24208053920","type":"CDM"},{"code":"24208053920","type":"NDC"}],"standard_charges":[{"gross_charge":118.53,"discounted_cash":41.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OPHTH OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208055555","type":"CDM"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":31.63,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208058060","type":"CDM"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"gross_charge":49.81,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208063562","type":"CDM"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":66.67,"discounted_cash":23.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFACETAMIDE SODIUM OPHTH SOLN 10%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208067004","type":"CDM"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"gross_charge":60.16,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208072002","type":"CDM"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":65.52,"discounted_cash":22.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208073006","type":"CDM"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":48.93,"discounted_cash":17.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24208073501","type":"CDM"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":6.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-BACITRAC ZN-POLYMYX 5(3.5)MG-400UNT-10000UNT OP OIN","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208078055","type":"CDM"},{"code":"24208078055","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN-NEOMYCIN-HC OPHTH OINT 1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208078555","type":"CDM"},{"code":"24208078555","type":"NDC"}],"standard_charges":[{"gross_charge":36.17,"discounted_cash":12.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-POLYMY-GRAMICID OP SOL 1.75-10000-0.025MG-UNT-MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208079062","type":"CDM"},{"code":"24208079062","type":"NDC"}],"standard_charges":[{"gross_charge":70.17,"discounted_cash":24.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208079535","type":"CDM"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":19.72,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH OINT 1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208082555","type":"CDM"},{"code":"24208082555","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx24208091019","type":"CDM"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208091055","type":"CDM"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETRACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208092064","type":"CDM"},{"code":"24208092064","type":"NDC"}],"standard_charges":[{"gross_charge":9.33,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24338013013","type":"CDM"},{"code":"24338013013","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"discounted_cash":10.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24338013402","type":"CDM"},{"code":"24338013402","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TL SOLN 0.4 MG/SPRAY (400 MCG/SPRAY)","drug_information":{"unit":4.9,"type":"GM"},"code_information":[{"code":"Rx24338030065","type":"CDM"},{"code":"24338030065","type":"NDC"}],"standard_charges":[{"gross_charge":303.73,"discounted_cash":106.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K-CA 2-3.5 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571010306","type":"CDM"},{"code":"24571010306","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICARB 32 MEQ/L-DEXT SOLN WITH K-CA 4-2.5 MEQ/L (CRRT)","drug_information":{"unit":5000.0,"type":"ML"},"code_information":[{"code":"Rx24571010506","type":"CDM"},{"code":"24571010506","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24689079302","type":"CDM"},{"code":"24689079302","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979002607","type":"CDM"},{"code":"24979002607","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979002707","type":"CDM"},{"code":"24979002707","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979002807","type":"CDM"},{"code":"24979002807","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979010106","type":"CDM"},{"code":"24979010106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979010107","type":"CDM"},{"code":"24979010107","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24987026010","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"24987026010","type":"NDC"}],"standard_charges":[{"gross_charge":745.49,"discounted_cash":260.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24987037710","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"24987037710","type":"NDC"}],"standard_charges":[{"gross_charge":99.35,"discounted_cash":34.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010021027","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"25010021027","type":"NDC"}],"standard_charges":[{"gross_charge":51491.32,"discounted_cash":18021.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010021515","type":"CDM"},{"code":"25010021515","type":"NDC"}],"standard_charges":[{"gross_charge":33.6,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010299","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"25021010299","type":"NDC"}],"standard_charges":[{"gross_charge":97.89,"discounted_cash":34.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010720","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"25021010720","type":"NDC"}],"standard_charges":[{"gross_charge":96.89,"discounted_cash":33.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021011020","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"25021011020","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021011487","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021011487","type":"NDC"}],"standard_charges":[{"gross_charge":243.1,"discounted_cash":85.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021011506","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"25021011506","type":"NDC"}],"standard_charges":[{"gross_charge":94.83,"discounted_cash":33.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012250","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"gross_charge":100.36,"discounted_cash":35.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012720","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"gross_charge":97.39,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021013182","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"25021013182","type":"NDC"}],"standard_charges":[{"gross_charge":242.6,"discounted_cash":84.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021013281","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013281","type":"NDC"}],"standard_charges":[{"gross_charge":244.05,"discounted_cash":85.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021013282","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":245.5,"discounted_cash":85.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013910","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"25021013910","type":"NDC"}],"standard_charges":[{"gross_charge":96.04,"discounted_cash":33.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014010","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"25021014010","type":"NDC"}],"standard_charges":[{"gross_charge":231.15,"discounted_cash":80.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021016224","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"25021016224","type":"NDC"}],"standard_charges":[{"gross_charge":231.15,"discounted_cash":80.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021017520","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021017520","type":"NDC"}],"standard_charges":[{"gross_charge":94.62,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021018482","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":244.2,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021018487","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":244.5,"discounted_cash":85.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019111","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019111","type":"NDC"}],"standard_charges":[{"gross_charge":245.87,"discounted_cash":86.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021019287","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021019287","type":"NDC"}],"standard_charges":[{"gross_charge":243.1,"discounted_cash":85.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021020110","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"25021020110","type":"NDC"}],"standard_charges":[{"gross_charge":287.64,"discounted_cash":100.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021020111","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"25021020111","type":"NDC"}],"standard_charges":[{"gross_charge":287.37,"discounted_cash":100.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021021350","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"25021021350","type":"NDC"}],"standard_charges":[{"gross_charge":583.73,"discounted_cash":204.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021022201","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"25021022201","type":"NDC"}],"standard_charges":[{"gross_charge":732.09,"discounted_cash":256.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx25021022204","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"25021022204","type":"NDC"}],"standard_charges":[{"gross_charge":1886.19,"discounted_cash":660.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYTARABINE INJ PF 20 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021022905","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"25021022905","type":"NDC"}],"standard_charges":[{"gross_charge":263.19,"discounted_cash":92.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021023550","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"25021023550","type":"NDC"}],"standard_charges":[{"gross_charge":278.85,"discounted_cash":97.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOCETAXEL FOR INJ CONC 20 MG/ML,DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),DOCETAXEL FOR INJ CONC 160 MG/8ML (20 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx25021024504","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"25021024504","type":"NDC"}],"standard_charges":[{"gross_charge":470.63,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021025350","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"25021025350","type":"NDC"}],"standard_charges":[{"gross_charge":286.85,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PACLITAXEL IV CONC 30 MG/5ML (6 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx25021025505","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"25021025505","type":"NDC"}],"standard_charges":[{"gross_charge":286.5,"discounted_cash":100.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021030102","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"25021030102","type":"NDC"}],"standard_charges":[{"gross_charge":95.59,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021030520","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"25021030520","type":"NDC"}],"standard_charges":[{"gross_charge":324.46,"discounted_cash":113.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx25021030730","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"25021030730","type":"NDC"}],"standard_charges":[{"gross_charge":2038.84,"discounted_cash":713.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021031102","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"25021031102","type":"NDC"}],"standard_charges":[{"gross_charge":93.58,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021031104","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"25021031104","type":"NDC"}],"standard_charges":[{"gross_charge":93.42,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx25021031604","type":"CDM"},{"code":"25021031604","type":"NDC"}],"standard_charges":[{"gross_charge":97.51,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031720","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"25021031720","type":"NDC"}],"standard_charges":[{"gross_charge":93.43,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031802","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"25021031802","type":"NDC"}],"standard_charges":[{"gross_charge":95.67,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021041510","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"25021041510","type":"NDC"}],"standard_charges":[{"gross_charge":94.99,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021050002","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"gross_charge":94.62,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAFFEINE CITRATE ORAL SOLN 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx25021060203","type":"CDM"},{"code":"25021060203","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021061110","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"25021061110","type":"NDC"}],"standard_charges":[{"gross_charge":95.54,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATRACURIUM BESYLATE PRESERVATIVE FREE (PF) IV SOLN 50 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021065905","type":"CDM"},{"code":"25021065905","type":"NDC"}],"standard_charges":[{"gross_charge":95.01,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATRACURIUM BESYLATE IV SOLN 100 MG/10ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021067210","type":"CDM"},{"code":"25021067210","type":"NDC"}],"standard_charges":[{"gross_charge":95.55,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":11.0,"type":"ML"},"code_information":[{"code":"Rx25021067377","type":"CDM"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOBARBITAL SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021067620","type":"CDM"},{"code":"J2515","type":"HCPCS"},{"code":"25021067620","type":"NDC"}],"standard_charges":[{"gross_charge":743.89,"discounted_cash":260.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOBARBITAL SODIUM INJ 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021067650","type":"CDM"},{"code":"J2515","type":"HCPCS"},{"code":"25021067650","type":"NDC"}],"standard_charges":[{"gross_charge":479.27,"discounted_cash":167.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx25021070587","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"25021070587","type":"NDC"}],"standard_charges":[{"gross_charge":96.37,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021077702","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"25021077702","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx25021081230","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"25021081230","type":"NDC"}],"standard_charges":[{"gross_charge":213.02,"discounted_cash":74.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081310","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081310","type":"NDC"}],"standard_charges":[{"gross_charge":264.12,"discounted_cash":92.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081430","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081430","type":"NDC"}],"standard_charges":[{"gross_charge":286.32,"discounted_cash":100.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081630","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081630","type":"NDC"}],"standard_charges":[{"gross_charge":239.53,"discounted_cash":83.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ECULIZUMAB IV SOLN 300 MG/30ML (10 MG/ML) (FOR INFUSION)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx25682000101","type":"CDM"},{"code":"J1299","type":"HCPCS"},{"code":"25682000101","type":"NDC"}],"standard_charges":[{"gross_charge":72692.25,"discounted_cash":25442.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241006303","type":"CDM"},{"code":"27241006303","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241013436","type":"CDM"},{"code":"27241013436","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx27241013909","type":"CDM"},{"code":"27241013909","type":"NDC"}],"standard_charges":[{"gross_charge":9.37,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILODOSIN CAP 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241014501","type":"CDM"},{"code":"27241014501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILODOSIN CAP 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241014503","type":"CDM"},{"code":"27241014503","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241016101","type":"CDM"},{"code":"27241016101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR MODIFIED RELEASE 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241024001","type":"CDM"},{"code":"27241024001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THEOPHYLLINE SOLN 80 MG/15ML","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx27808003301","type":"CDM"},{"code":"27808003301","type":"NDC"}],"standard_charges":[{"gross_charge":63.14,"discounted_cash":22.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29033002602","type":"CDM"},{"code":"29033002602","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300022701","type":"CDM"},{"code":"29300022701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722000530","type":"CDM"},{"code":"31722000530","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPLERENONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722004930","type":"CDM"},{"code":"31722004930","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722013130","type":"CDM"},{"code":"31722013130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722013190","type":"CDM"},{"code":"31722013190","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBINAFINE HCL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722020901","type":"CDM"},{"code":"31722020901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722025301","type":"CDM"},{"code":"31722025301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722025601","type":"CDM"},{"code":"31722025601","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722027734","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"31722027734","type":"NDC"}],"standard_charges":[{"gross_charge":93.72,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722030801","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"31722030801","type":"NDC"}],"standard_charges":[{"gross_charge":133.61,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"STAVUDINE CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722051660","type":"CDM"},{"code":"31722051660","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053001","type":"CDM"},{"code":"31722053001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053101","type":"CDM"},{"code":"31722053101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053712","type":"CDM"},{"code":"31722053712","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722062921","type":"CDM"},{"code":"31722062921","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722063031","type":"CDM"},{"code":"31722063031","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILODOSIN CAP 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722063530","type":"CDM"},{"code":"31722063530","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722070190","type":"CDM"},{"code":"31722070190","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722077690","type":"CDM"},{"code":"31722077690","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722083260","type":"CDM"},{"code":"31722083260","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTECAVIR TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722083330","type":"CDM"},{"code":"31722083330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOLVAPTAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722086803","type":"CDM"},{"code":"31722086803","type":"NDC"}],"standard_charges":[{"gross_charge":89.99,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMIVUDINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342000109","type":"CDM"},{"code":"33342000109","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAMCICLOVIR TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002507","type":"CDM"},{"code":"33342002507","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAMCICLOVIR TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002607","type":"CDM"},{"code":"33342002607","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002710","type":"CDM"},{"code":"33342002710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRBESARTAN TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342004710","type":"CDM"},{"code":"33342004710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRBESARTAN TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342004810","type":"CDM"},{"code":"33342004810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342006207","type":"CDM"},{"code":"33342006207","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008307","type":"CDM"},{"code":"33342008307","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008311","type":"CDM"},{"code":"33342008311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009607","type":"CDM"},{"code":"33342009607","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342011010","type":"CDM"},{"code":"33342011010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342011107","type":"CDM"},{"code":"33342011107","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342027407","type":"CDM"},{"code":"33342027407","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx33342033315","type":"CDM"},{"code":"33342033315","type":"NDC"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":80.0,"type":"GM"},"code_information":[{"code":"Rx33342033380","type":"CDM"},{"code":"33342033380","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx33342040530","type":"CDM"},{"code":"33342040530","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000124","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"36000000124","type":"NDC"}],"standard_charges":[{"gross_charge":243.6,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":243.5,"discounted_cash":85.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx36000000306","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":248.1,"discounted_cash":86.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000000306","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":244.3,"discounted_cash":85.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000001225","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"36000001225","type":"NDC"}],"standard_charges":[{"gross_charge":93.66,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000004624","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"36000004624","type":"NDC"}],"standard_charges":[{"gross_charge":242.55,"discounted_cash":84.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 100 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx36000026110","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"36000026110","type":"NDC"}],"standard_charges":[{"gross_charge":245.6,"discounted_cash":85.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028225","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028325","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028425","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028425","type":"NDC"}],"standard_charges":[{"gross_charge":93.34,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx36000030810","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"gross_charge":93.9,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000032001","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"36000032001","type":"NDC"}],"standard_charges":[{"gross_charge":94.87,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000032010","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"gross_charge":94.85,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL SOLN 50 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx39328053016","type":"CDM"},{"code":"39328053016","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822017001","type":"CDM"},{"code":"39822017001","type":"NDC"}],"standard_charges":[{"gross_charge":100.53,"discounted_cash":35.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822019001","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"gross_charge":300.27,"discounted_cash":105.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN SULFATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822031005","type":"CDM"},{"code":"39822031005","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN SULFATE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822031007","type":"CDM"},{"code":"39822031007","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822041201","type":"CDM"},{"code":"39822041201","type":"NDC"}],"standard_charges":[{"gross_charge":574.89,"discounted_cash":201.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COLISTIMETHATE SOD FOR INJ 150 MG (COLISTIN BASE ACTIVITY)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822061501","type":"CDM"},{"code":"J0770","type":"HCPCS"},{"code":"39822061501","type":"NDC"}],"standard_charges":[{"gross_charge":293.32,"discounted_cash":102.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"STREPTOMYCIN SULFATE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822070602","type":"CDM"},{"code":"J3000","type":"HCPCS"},{"code":"39822070602","type":"NDC"}],"standard_charges":[{"gross_charge":459.11,"discounted_cash":160.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx39822071001","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"39822071001","type":"NDC"}],"standard_charges":[{"gross_charge":6366.07,"discounted_cash":2228.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHOTERICIN B FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822105505","type":"CDM"},{"code":"J0285","type":"HCPCS"},{"code":"39822105505","type":"NDC"}],"standard_charges":[{"gross_charge":387.52,"discounted_cash":135.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx39822110001","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":93.8,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx39822301501","type":"CDM"},{"code":"39822301501","type":"NDC"}],"standard_charges":[{"gross_charge":20.63,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx39822400001","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"39822400001","type":"NDC"}],"standard_charges":[{"gross_charge":96.02,"discounted_cash":33.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx39822402501","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"39822402501","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx39822552503","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"39822552503","type":"NDC"}],"standard_charges":[{"gross_charge":93.6,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx39822625001","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"39822625001","type":"NDC"}],"standard_charges":[{"gross_charge":96.57,"discounted_cash":33.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CADEXOMER IODINE GEL 0.9%","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"Rx40565012249","type":"CDM"},{"code":"40565012249","type":"NDC"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":25.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx41616093244","type":"CDM"},{"code":"41616093244","type":"NDC"}],"standard_charges":[{"gross_charge":178.19,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE HCL NASAL SOLN 0.1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023010301","type":"CDM"},{"code":"42023010301","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx42023010401","type":"CDM"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":113.03,"discounted_cash":39.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx42023010405","type":"CDM"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"gross_charge":101.11,"discounted_cash":35.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL VALERATE IM IN OIL 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023011201","type":"CDM"},{"code":"J1380","type":"HCPCS"},{"code":"42023011201","type":"NDC"}],"standard_charges":[{"gross_charge":159.4,"discounted_cash":55.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011625","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"gross_charge":96.55,"discounted_cash":33.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023012306","type":"CDM"},{"code":"42023012306","type":"NDC"}],"standard_charges":[{"gross_charge":909.96,"discounted_cash":318.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023012401","type":"CDM"},{"code":"42023012401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023015901","type":"CDM"},{"code":"42023015901","type":"NDC"}],"standard_charges":[{"gross_charge":95.84,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023015925","type":"CDM"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"gross_charge":94.71,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023016801","type":"CDM"},{"code":"42023016801","type":"NDC"}],"standard_charges":[{"gross_charge":93.82,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL CREAM 2.5-1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx42192010701","type":"CDM"},{"code":"42192010701","type":"NDC"}],"standard_charges":[{"gross_charge":42.07,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THYROID TAB 15 MG (1/4 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192032701","type":"CDM"},{"code":"42192032701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THYROID TAB 30 MG (1/2 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192032901","type":"CDM"},{"code":"42192032901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192033901","type":"CDM"},{"code":"42192033901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42192060805","type":"CDM"},{"code":"42192060805","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42192060806","type":"CDM"},{"code":"42192060806","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192080101","type":"CDM"},{"code":"42192080101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192080201","type":"CDM"},{"code":"42192080201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42291066890","type":"CDM"},{"code":"42291066890","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003920","type":"CDM"},{"code":"42292003920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42494041501","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041501","type":"NDC"}],"standard_charges":[{"gross_charge":250.71,"discounted_cash":87.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42494041525","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041525","type":"NDC"}],"standard_charges":[{"gross_charge":148.02,"discounted_cash":51.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx42494041601","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041601","type":"NDC"}],"standard_charges":[{"gross_charge":293.06,"discounted_cash":102.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx42494041625","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"gross_charge":166.09,"discounted_cash":58.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42494045020","type":"CDM"},{"code":"42494045020","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543014101","type":"CDM"},{"code":"42543014101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CITRATE TAB ER 10 MEQ (1080 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543040701","type":"CDM"},{"code":"42543040701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543070330","type":"CDM"},{"code":"42543070330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543070390","type":"CDM"},{"code":"42543070390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571016101","type":"CDM"},{"code":"42571016101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOBAZAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571031501","type":"CDM"},{"code":"42571031501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx42702010215","type":"CDM"},{"code":"42702010215","type":"NDC"}],"standard_charges":[{"gross_charge":124.71,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42794001802","type":"CDM"},{"code":"42794001802","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42794001812","type":"CDM"},{"code":"42794001812","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42794001902","type":"CDM"},{"code":"42794001902","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IVERMECTIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42799080601","type":"CDM"},{"code":"42799080601","type":"NDC"}],"standard_charges":[{"gross_charge":5.69,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULINDAC TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806001801","type":"CDM"},{"code":"42806001801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806014301","type":"CDM"},{"code":"42806014301","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx42806015134","type":"CDM"},{"code":"42806015134","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTECAVIR TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806065830","type":"CDM"},{"code":"42806065830","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806071401","type":"CDM"},{"code":"42806071401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFADIAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806075760","type":"CDM"},{"code":"42806075760","type":"NDC"}],"standard_charges":[{"gross_charge":22.03,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858000110","type":"CDM"},{"code":"42858000110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858000201","type":"CDM"},{"code":"42858000201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030101","type":"CDM"},{"code":"42858030101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030125","type":"CDM"},{"code":"42858030125","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030201","type":"CDM"},{"code":"42858030201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030225","type":"CDM"},{"code":"42858030225","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858066045","type":"CDM"},{"code":"42858066045","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858080201","type":"CDM"},{"code":"42858080201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858080401","type":"CDM"},{"code":"42858080401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42937070210","type":"CDM"},{"code":"42937070210","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42998030202","type":"CDM"},{"code":"42998030202","type":"NDC"}],"standard_charges":[{"gross_charge":6757.07,"discounted_cash":2364.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066001501","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066001501","type":"NDC"}],"standard_charges":[{"gross_charge":94.07,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066001510","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066001510","type":"NDC"}],"standard_charges":[{"gross_charge":93.82,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx43066001610","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"43066001610","type":"NDC"}],"standard_charges":[{"gross_charge":668.16,"discounted_cash":233.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43066004101","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"43066004101","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43066004125","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"43066004125","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 4.21% IV SOLN 150 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43066015010","type":"CDM"},{"code":"J0283","type":"HCPCS"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 4.14% IV SOLN 360 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx43066036020","type":"CDM"},{"code":"J0283","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":296.96,"discounted_cash":103.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx43066099324","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"43066099324","type":"NDC"}],"standard_charges":[{"gross_charge":250.3,"discounted_cash":87.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHENAMINE HIPPURATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199002001","type":"CDM"},{"code":"43199002001","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx43199002915","type":"CDM"},{"code":"43199002915","type":"NDC"}],"standard_charges":[{"gross_charge":13.43,"discounted_cash":4.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386014028","type":"CDM"},{"code":"43386014028","type":"NDC"}],"standard_charges":[{"gross_charge":74.73,"discounted_cash":26.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENELZINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386036021","type":"CDM"},{"code":"43386036021","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386044024","type":"CDM"},{"code":"43386044024","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx43386050011","type":"CDM"},{"code":"43386050011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE ENEMA 4 GM","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx43386051087","type":"CDM"},{"code":"43386051087","type":"NDC"}],"standard_charges":[{"gross_charge":14.76,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCYTOSINE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386077001","type":"CDM"},{"code":"43386077001","type":"NDC"}],"standard_charges":[{"gross_charge":27.9,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547025410","type":"CDM"},{"code":"43547025410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547025510","type":"CDM"},{"code":"43547025510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547026910","type":"CDM"},{"code":"43547026910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027010","type":"CDM"},{"code":"43547027010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547028210","type":"CDM"},{"code":"43547028210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547029503","type":"CDM"},{"code":"43547029503","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547036009","type":"CDM"},{"code":"43547036009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547036703","type":"CDM"},{"code":"43547036703","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547036809","type":"CDM"},{"code":"43547036809","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547036909","type":"CDM"},{"code":"43547036909","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040110","type":"CDM"},{"code":"43547040110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040210","type":"CDM"},{"code":"43547040210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040610","type":"CDM"},{"code":"43547040610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040710","type":"CDM"},{"code":"43547040710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 125-31.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598001251","type":"CDM"},{"code":"43598001251","type":"NDC"}],"standard_charges":[{"gross_charge":38.94,"discounted_cash":13.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598008758","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"43598008758","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598012811","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598012811","type":"NDC"}],"standard_charges":[{"gross_charge":149.74,"discounted_cash":52.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598016430","type":"CDM"},{"code":"43598016430","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598016911","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598016911","type":"NDC"}],"standard_charges":[{"gross_charge":96.62,"discounted_cash":33.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598016958","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598016958","type":"NDC"}],"standard_charges":[{"gross_charge":96.54,"discounted_cash":33.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":400.0,"type":"GM"},"code_information":[{"code":"Rx43598021040","type":"CDM"},{"code":"43598021040","type":"NDC"}],"standard_charges":[{"gross_charge":73.2,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx43598021085","type":"CDM"},{"code":"43598021085","type":"NDC"}],"standard_charges":[{"gross_charge":30.47,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598029266","type":"CDM"},{"code":"43598029266","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE OTIC SUSP 0.3-0.1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598032675","type":"CDM"},{"code":"43598032675","type":"NDC"}],"standard_charges":[{"gross_charge":158.61,"discounted_cash":55.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598037074","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"43598037074","type":"NDC"}],"standard_charges":[{"gross_charge":1476.36,"discounted_cash":516.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx43598040516","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598047801","type":"CDM"},{"code":"43598047801","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598047890","type":"CDM"},{"code":"43598047890","type":"NDC"}],"standard_charges":[{"gross_charge":13.19,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx43598052911","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"43598052911","type":"NDC"}],"standard_charges":[{"gross_charge":99.67,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx43598052936","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"43598052936","type":"NDC"}],"standard_charges":[{"gross_charge":96.46,"discounted_cash":33.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598057930","type":"CDM"},{"code":"43598057930","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598058230","type":"CDM"},{"code":"43598058230","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598065530","type":"CDM"},{"code":"43598065530","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598071901","type":"CDM"},{"code":"43598071901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598072101","type":"CDM"},{"code":"43598072101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598075011","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"43598075011","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598075058","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"43598075058","type":"NDC"}],"standard_charges":[{"gross_charge":95.81,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598091406","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"43598091406","type":"NDC"}],"standard_charges":[{"gross_charge":95.77,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598091411","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"43598091411","type":"NDC"}],"standard_charges":[{"gross_charge":95.82,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598093109","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"43598093109","type":"NDC"}],"standard_charges":[{"gross_charge":97.69,"discounted_cash":34.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598093111","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"43598093111","type":"NDC"}],"standard_charges":[{"gross_charge":100.18,"discounted_cash":35.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598094811","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"43598094811","type":"NDC"}],"standard_charges":[{"gross_charge":239.56,"discounted_cash":83.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx43825010201","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"43825010201","type":"NDC"}],"standard_charges":[{"gross_charge":97.47,"discounted_cash":34.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THROMBIN (RECOMBINANT) FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43825060641","type":"CDM"},{"code":"43825060641","type":"NDC"}],"standard_charges":[{"gross_charge":672.67,"discounted_cash":235.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THROMBIN (RECOMBINANT) FOR SOLN 20000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43825070741","type":"CDM"},{"code":"43825070741","type":"NDC"}],"standard_charges":[{"gross_charge":2690.8,"discounted_cash":941.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975032203","type":"CDM"},{"code":"43975032203","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975032209","type":"CDM"},{"code":"43975032209","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN SOL PREF SYR 1500 UNT/2ML (300MCG/2ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx44206030001","type":"CDM"},{"code":"J2791","type":"HCPCS"},{"code":"44206030001","type":"NDC"}],"standard_charges":[{"gross_charge":707.28,"discounted_cash":247.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567010110","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"44567010110","type":"NDC"}],"standard_charges":[{"gross_charge":94.05,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567021110","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"gross_charge":96.49,"discounted_cash":33.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567022110","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"44567022110","type":"NDC"}],"standard_charges":[{"gross_charge":97.69,"discounted_cash":34.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567023525","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"gross_charge":95.92,"discounted_cash":33.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024010","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"gross_charge":95.9,"discounted_cash":33.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024110","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"gross_charge":100.56,"discounted_cash":35.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024525","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"44567024525","type":"NDC"}],"standard_charges":[{"gross_charge":95.54,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024625","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"44567024625","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":34.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567031110","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"gross_charge":97.23,"discounted_cash":34.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567041024","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567041024","type":"NDC"}],"standard_charges":[{"gross_charge":242.5,"discounted_cash":84.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567043524","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"44567043524","type":"NDC"}],"standard_charges":[{"gross_charge":247.1,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567045010","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"44567045010","type":"NDC"}],"standard_charges":[{"gross_charge":765.6,"discounted_cash":267.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL-DEXTROSE IV SOLN 400 MCG/100ML-5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567060324","type":"CDM"},{"code":"44567060324","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567061101","type":"CDM"},{"code":"J2251","type":"HCPCS"},{"code":"44567061101","type":"NDC"}],"standard_charges":[{"gross_charge":360.28,"discounted_cash":126.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567061110","type":"CDM"},{"code":"J2251","type":"HCPCS"},{"code":"44567061110","type":"NDC"}],"standard_charges":[{"gross_charge":202.8,"discounted_cash":70.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 1 GM/50ML-0.675% (20 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567062001","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062001","type":"NDC"}],"standard_charges":[{"gross_charge":248.35,"discounted_cash":86.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 1 GM/50ML-0.675% (20 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567062024","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062024","type":"NDC"}],"standard_charges":[{"gross_charge":248.35,"discounted_cash":86.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567062101","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062101","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567062124","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062124","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-SODIUM CHLORIDE IV SOLN 1 GM/100ML-0.8%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567062201","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062201","type":"NDC"}],"standard_charges":[{"gross_charge":248.9,"discounted_cash":87.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 4 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064010","type":"CDM"},{"code":"44567064010","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064101","type":"CDM"},{"code":"44567064101","type":"NDC"}],"standard_charges":[{"gross_charge":478.5,"discounted_cash":167.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064110","type":"CDM"},{"code":"44567064110","type":"NDC"}],"standard_charges":[{"gross_charge":249.4,"discounted_cash":87.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070725","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"44567070725","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":33.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070810","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"gross_charge":112.81,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SELENIUM SULFIDE LOTION 2.5%","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx45802004064","type":"CDM"},{"code":"45802004064","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE OINT 0.1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802004611","type":"CDM"},{"code":"45802004611","type":"NDC"}],"standard_charges":[{"gross_charge":112.59,"discounted_cash":39.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802004635","type":"CDM"},{"code":"45802004635","type":"NDC"}],"standard_charges":[{"gross_charge":56.29,"discounted_cash":19.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802004811","type":"CDM"},{"code":"45802004811","type":"NDC"}],"standard_charges":[{"gross_charge":28.98,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE CREAM 0.1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802005611","type":"CDM"},{"code":"45802005611","type":"NDC"}],"standard_charges":[{"gross_charge":112.59,"discounted_cash":39.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802005635","type":"CDM"},{"code":"45802005635","type":"NDC"}],"standard_charges":[{"gross_charge":55.1,"discounted_cash":19.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802005935","type":"CDM"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802006435","type":"CDM"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx45802009735","type":"CDM"},{"code":"45802009735","type":"NDC"}],"standard_charges":[{"gross_charge":142.48,"discounted_cash":49.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE ENEMA 4 GM","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx45802009846","type":"CDM"},{"code":"45802009846","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE ENEMA 4 GM","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx45802009851","type":"CDM"},{"code":"45802009851","type":"NDC"}],"standard_charges":[{"gross_charge":13.77,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx45802011222","type":"CDM"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":12.83,"discounted_cash":4.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL CREAM 1-1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802014464","type":"CDM"},{"code":"45802014464","type":"NDC"}],"standard_charges":[{"gross_charge":156.37,"discounted_cash":54.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE ACETATE W/ PRAMOXINE PERIANAL CREAM 2.5-1%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802047264","type":"CDM"},{"code":"45802047264","type":"NDC"}],"standard_charges":[{"gross_charge":132.43,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERCONAZOLE VAGINAL SUPPOS 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802071708","type":"CDM"},{"code":"45802071708","type":"NDC"}],"standard_charges":[{"gross_charge":38.77,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802088014","type":"CDM"},{"code":"45802088014","type":"NDC"}],"standard_charges":[{"gross_charge":13.43,"discounted_cash":4.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN INTRATHECAL INJ 10 MG/20ML (500 MCG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx45945015502","type":"CDM"},{"code":"J0475","type":"HCPCS"},{"code":"45945015502","type":"NDC"}],"standard_charges":[{"gross_charge":1884.96,"discounted_cash":659.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963041806","type":"CDM"},{"code":"45963041806","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTULOSE (ENCEPHALOPATHY) SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx45963043864","type":"CDM"},{"code":"45963043864","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx45963043965","type":"CDM"},{"code":"45963043965","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963067611","type":"CDM"},{"code":"45963067611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx45963073357","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"45963073357","type":"NDC"}],"standard_charges":[{"gross_charge":313.32,"discounted_cash":109.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx45963073368","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"45963073368","type":"NDC"}],"standard_charges":[{"gross_charge":343.88,"discounted_cash":120.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE SUSP 15 GM/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx46287000660","type":"CDM"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":33.21,"discounted_cash":11.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISONIAZID SYRUP 50 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx46287000901","type":"CDM"},{"code":"46287000901","type":"NDC"}],"standard_charges":[{"gross_charge":20.92,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE SUSP 25 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx46287002001","type":"CDM"},{"code":"46287002001","type":"NDC"}],"standard_charges":[{"gross_charge":8.87,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335000788","type":"CDM"},{"code":"47335000788","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx47335008250","type":"CDM"},{"code":"Q2049","type":"HCPCS"},{"code":"47335008250","type":"NDC"}],"standard_charges":[{"gross_charge":9359.98,"discounted_cash":3275.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335015440","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"47335015440","type":"NDC"}],"standard_charges":[{"gross_charge":1445.97,"discounted_cash":506.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335023596","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"47335023596","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335048583","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"47335048583","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335048588","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"47335048588","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx47335099202","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"47335099202","type":"NDC"}],"standard_charges":[{"gross_charge":243.8,"discounted_cash":85.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx47335099301","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":85.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"APREPITANT IV EMULSION 130 MG/18ML","drug_information":{"unit":18.0,"type":"ML"},"code_information":[{"code":"Rx47426020101","type":"CDM"},{"code":"J0185","type":"HCPCS"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":2574.23,"discounted_cash":900.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781001301","type":"CDM"},{"code":"47781001301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EXEMESTANE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781010830","type":"CDM"},{"code":"47781010830","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781020611","type":"CDM"},{"code":"47781020611","type":"NDC"}],"standard_charges":[{"gross_charge":22.59,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781030301","type":"CDM"},{"code":"47781030301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781030801","type":"CDM"},{"code":"47781030801","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035503","type":"CDM"},{"code":"47781035503","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035703","type":"CDM"},{"code":"47781035703","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781046813","type":"CDM"},{"code":"47781046813","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx47781056972","type":"CDM"},{"code":"47781056972","type":"NDC"}],"standard_charges":[{"gross_charge":56.47,"discounted_cash":19.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781059707","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"47781059707","type":"NDC"}],"standard_charges":[{"gross_charge":98.82,"discounted_cash":34.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx47781061620","type":"CDM"},{"code":"47781061620","type":"NDC"}],"standard_charges":[{"gross_charge":94.66,"discounted_cash":33.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IODINE SOLUTION STRONG 5% (LUGOL'S)","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"Rx48433023015","type":"CDM"},{"code":"48433023015","type":"NDC"}],"standard_charges":[{"gross_charge":46.57,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FERRIC SUBSULFATE PASTE","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx48783011208","type":"CDM"},{"code":"48783011208","type":"NDC"}],"standard_charges":[{"gross_charge":29.26,"discounted_cash":10.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021515","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":454.54,"discounted_cash":159.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPH, ACELLULAR PERT & TET TOX INJ 15 LF-23 MCG-5 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281028610","type":"CDM"},{"code":"90700","type":"HCPCS"},{"code":"49281028610","type":"NDC"}],"standard_charges":[{"gross_charge":315.94,"discounted_cash":110.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VACCINE FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281054503","type":"CDM"},{"code":"90648","type":"HCPCS"},{"code":"49281054503","type":"NDC"}],"standard_charges":[{"gross_charge":141.94,"discounted_cash":49.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPH-AC PER-TET TOX AD-POLIOV-HAEMOPH B POLY VAC FOR IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281056005","type":"CDM"},{"code":"90698","type":"HCPCS"},{"code":"49281056005","type":"NDC"}],"standard_charges":[{"gross_charge":692.51,"discounted_cash":242.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx49281057415","type":"CDM"},{"code":"90381","type":"HCPCS"},{"code":"49281057415","type":"NDC"}],"standard_charges":[{"gross_charge":5025.75,"discounted_cash":1759.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281057515","type":"CDM"},{"code":"90380","type":"HCPCS"},{"code":"49281057515","type":"NDC"}],"standard_charges":[{"gross_charge":5025.75,"discounted_cash":1759.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx49281075221","type":"CDM"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":118.72,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx49281075278","type":"CDM"},{"code":"49281075278","type":"NDC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":34.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BELIMUMAB FOR IV SOLN 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49401010101","type":"CDM"},{"code":"J0490","type":"HCPCS"},{"code":"49401010101","type":"NDC"}],"standard_charges":[{"gross_charge":7215.15,"discounted_cash":2525.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BELIMUMAB FOR IV SOLN 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49401010201","type":"CDM"},{"code":"J0490","type":"HCPCS"},{"code":"49401010201","type":"NDC"}],"standard_charges":[{"gross_charge":24048.86,"discounted_cash":8417.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PARICALCITOL CAP 1 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483068703","type":"CDM"},{"code":"49483068703","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502010102","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502010102","type":"NDC"}],"standard_charges":[{"gross_charge":1462.88,"discounted_cash":512.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502010201","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502010201","type":"NDC"}],"standard_charges":[{"gross_charge":1479.35,"discounted_cash":517.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502010202","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502010202","type":"NDC"}],"standard_charges":[{"gross_charge":1462.88,"discounted_cash":512.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502050002","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502050002","type":"NDC"}],"standard_charges":[{"gross_charge":3092.71,"discounted_cash":1082.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502050102","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502050102","type":"NDC"}],"standard_charges":[{"gross_charge":3092.71,"discounted_cash":1082.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CANDIDA ALBICANS SKIN TEST ANTIGEN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx496430138RX","type":"CDM"},{"code":"86485","type":"HCPCS"},{"code":"496430138RX","type":"NDC"}],"standard_charges":[{"gross_charge":136.41,"discounted_cash":47.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIDOVUDINE IV SOLN 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx49702021301","type":"CDM"},{"code":"J3485","type":"HCPCS"},{"code":"49702021301","type":"NDC"}],"standard_charges":[{"gross_charge":303.07,"discounted_cash":106.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIDOVUDINE IV SOLN 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx49702021305","type":"CDM"},{"code":"J3485","type":"HCPCS"},{"code":"49702021305","type":"NDC"}],"standard_charges":[{"gross_charge":305.53,"discounted_cash":106.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIDOVUDINE IV SOLN 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx49702021326","type":"CDM"},{"code":"J3485","type":"HCPCS"},{"code":"49702021326","type":"NDC"}],"standard_charges":[{"gross_charge":299.71,"discounted_cash":104.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOLUTEGRAVIR SODIUM TAB 50 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49702022813","type":"CDM"},{"code":"49702022813","type":"NDC"}],"standard_charges":[{"gross_charge":106.56,"discounted_cash":37.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49730011130","type":"CDM"},{"code":"49730011130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOMYCIN FOR OPHTH SOLN KIT 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49771000201","type":"CDM"},{"code":"J7315","type":"HCPCS"},{"code":"49771000201","type":"NDC"}],"standard_charges":[{"gross_charge":4312.75,"discounted_cash":1509.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884002101","type":"CDM"},{"code":"49884002101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884002201","type":"CDM"},{"code":"49884002201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884025601","type":"CDM"},{"code":"49884025601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884030702","type":"CDM"},{"code":"49884030702","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032052","type":"CDM"},{"code":"49884032052","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032055","type":"CDM"},{"code":"49884032055","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALISKIREN FUMARATE TAB 150 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884042411","type":"CDM"},{"code":"49884042411","type":"NDC"}],"standard_charges":[{"gross_charge":7.61,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884046564","type":"CDM"},{"code":"49884046564","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884046565","type":"CDM"},{"code":"49884046565","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884046663","type":"CDM"},{"code":"49884046663","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884046665","type":"CDM"},{"code":"49884046665","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884050101","type":"CDM"},{"code":"49884050101","type":"NDC"}],"standard_charges":[{"gross_charge":19.48,"discounted_cash":6.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884053411","type":"CDM"},{"code":"49884053411","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUTAMIDE CAP 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884075313","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"49884075313","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884082601","type":"CDM"},{"code":"49884082601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884082909","type":"CDM"},{"code":"49884082909","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884083011","type":"CDM"},{"code":"49884083011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884083109","type":"CDM"},{"code":"49884083109","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884086702","type":"CDM"},{"code":"49884086702","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx49884090738","type":"CDM"},{"code":"49884090738","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx49884090761","type":"CDM"},{"code":"49884090761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DAPSONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49938010130","type":"CDM"},{"code":"49938010130","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ULIPRISTAL ACETATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50102091101","type":"CDM"},{"code":"50102091101","type":"NDC"}],"standard_charges":[{"gross_charge":49.56,"discounted_cash":17.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THEOPHYLLINE TAB ER 12HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111045901","type":"CDM"},{"code":"50111045901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111046901","type":"CDM"},{"code":"50111046901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111056101","type":"CDM"},{"code":"50111056101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111091601","type":"CDM"},{"code":"50111091601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228010901","type":"CDM"},{"code":"50228010901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228012405","type":"CDM"},{"code":"50228012405","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228014601","type":"CDM"},{"code":"50228014601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228017501","type":"CDM"},{"code":"50228017501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228045701","type":"CDM"},{"code":"50228045701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALTEPLASE FOR INJ 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004164","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":1901.53,"discounted_cash":665.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALTEPLASE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004413","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004413","type":"NDC"}],"standard_charges":[{"gross_charge":45186.73,"discounted_cash":15815.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RITUXIMAB IV SOLN 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50242005121","type":"CDM"},{"code":"J9312","type":"HCPCS"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"gross_charge":9731.29,"discounted_cash":3405.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RITUXIMAB IV SOLN 500 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx50242005306","type":"CDM"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":48245.88,"discounted_cash":16886.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BEVACIZUMAB IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx50242006001","type":"CDM"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":8270.13,"discounted_cash":2894.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BEVACIZUMAB IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx50242006101","type":"CDM"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":32772.43,"discounted_cash":11470.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERLOTINIB HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242006201","type":"CDM"},{"code":"50242006201","type":"NDC"}],"standard_charges":[{"gross_charge":125.66,"discounted_cash":43.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERLOTINIB HCL TAB 100 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242006301","type":"CDM"},{"code":"50242006301","type":"NDC"}],"standard_charges":[{"gross_charge":345.16,"discounted_cash":120.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DORNASE ALFA INHAL SOLN 2.5 MG/2.5ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50242010039","type":"CDM"},{"code":"J7639","type":"HCPCS"},{"code":"50242010039","type":"NDC"}],"standard_charges":[{"gross_charge":172.2,"discounted_cash":60.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DORNASE ALFA INHAL SOLN 2.5 MG/2.5ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50242010040","type":"CDM"},{"code":"J7639","type":"HCPCS"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"gross_charge":220.71,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOCILIZUMAB IV INJ 80 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx50242013501","type":"CDM"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501","type":"NDC"}],"standard_charges":[{"gross_charge":5452.83,"discounted_cash":1908.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOCILIZUMAB IV INJ 200 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50242013601","type":"CDM"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":13632.19,"discounted_cash":4771.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOCILIZUMAB IV INJ 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx50242013701","type":"CDM"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":27264.38,"discounted_cash":9542.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242017601","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242017601","type":"NDC"}],"standard_charges":[{"gross_charge":85206.91,"discounted_cash":29822.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 150 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx50242021501","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242021501","type":"NDC"}],"standard_charges":[{"gross_charge":7890.62,"discounted_cash":2761.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003711","type":"CDM"},{"code":"50268003711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003715","type":"CDM"},{"code":"50268003715","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003911","type":"CDM"},{"code":"50268003911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005411","type":"CDM"},{"code":"50268005411","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005415","type":"CDM"},{"code":"50268005415","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006015","type":"CDM"},{"code":"50268006015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006115","type":"CDM"},{"code":"50268006115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006211","type":"CDM"},{"code":"50268006211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006215","type":"CDM"},{"code":"50268006215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007411","type":"CDM"},{"code":"50268007411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007415","type":"CDM"},{"code":"50268007415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007511","type":"CDM"},{"code":"50268007511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007515","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"50268007515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008215","type":"CDM"},{"code":"50268008215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008815","type":"CDM"},{"code":"50268008815","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008911","type":"CDM"},{"code":"50268008911","type":"NDC"}],"standard_charges":[{"gross_charge":7.19,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268009311","type":"CDM"},{"code":"50268009311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268009815","type":"CDM"},{"code":"50268009815","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BALSALAZIDE DISODIUM CAP 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010211","type":"CDM"},{"code":"50268010211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BALSALAZIDE DISODIUM CAP 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010213","type":"CDM"},{"code":"50268010213","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010615","type":"CDM"},{"code":"50268010615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011011","type":"CDM"},{"code":"50268011011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011015","type":"CDM"},{"code":"50268011015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013011","type":"CDM"},{"code":"50268013011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013015","type":"CDM"},{"code":"50268013015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015111","type":"CDM"},{"code":"50268015111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015115","type":"CDM"},{"code":"50268015115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016211","type":"CDM"},{"code":"50268016211","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268017711","type":"CDM"},{"code":"50268017711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268017715","type":"CDM"},{"code":"50268017715","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268027911","type":"CDM"},{"code":"50268027911","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029711","type":"CDM"},{"code":"50268029711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029715","type":"CDM"},{"code":"50268029715","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031211","type":"CDM"},{"code":"50268031211","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031215","type":"CDM"},{"code":"50268031215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033015","type":"CDM"},{"code":"50268033015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033711","type":"CDM"},{"code":"50268033711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035011","type":"CDM"},{"code":"50268035011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035015","type":"CDM"},{"code":"50268035015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035815","type":"CDM"},{"code":"50268035815","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040415","type":"CDM"},{"code":"50268040415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043015","type":"CDM"},{"code":"50268043015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043111","type":"CDM"},{"code":"50268043111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043115","type":"CDM"},{"code":"50268043115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268045215","type":"CDM"},{"code":"50268045215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268046815","type":"CDM"},{"code":"50268046815","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268046915","type":"CDM"},{"code":"50268046915","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268047011","type":"CDM"},{"code":"50268047011","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268047013","type":"CDM"},{"code":"50268047013","type":"NDC"}],"standard_charges":[{"gross_charge":4.78,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047611","type":"CDM"},{"code":"50268047611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047615","type":"CDM"},{"code":"50268047615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047711","type":"CDM"},{"code":"50268047711","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047715","type":"CDM"},{"code":"50268047715","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047815","type":"CDM"},{"code":"50268047815","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050411","type":"CDM"},{"code":"50268050411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052511","type":"CDM"},{"code":"50268052511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052515","type":"CDM"},{"code":"50268052515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052615","type":"CDM"},{"code":"50268052615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053511","type":"CDM"},{"code":"50268053511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053515","type":"CDM"},{"code":"50268053515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054015","type":"CDM"},{"code":"50268054015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054215","type":"CDM"},{"code":"50268054215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055011","type":"CDM"},{"code":"50268055011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055111","type":"CDM"},{"code":"50268055111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055115","type":"CDM"},{"code":"50268055115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056111","type":"CDM"},{"code":"50268056111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056115","type":"CDM"},{"code":"50268056115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057311","type":"CDM"},{"code":"50268057311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057315","type":"CDM"},{"code":"50268057315","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057415","type":"CDM"},{"code":"50268057415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059415","type":"CDM"},{"code":"50268059415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059711","type":"CDM"},{"code":"50268059711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059715","type":"CDM"},{"code":"50268059715","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060315","type":"CDM"},{"code":"50268060315","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060411","type":"CDM"},{"code":"50268060411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060415","type":"CDM"},{"code":"50268060415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062515","type":"CDM"},{"code":"50268062515","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062715","type":"CDM"},{"code":"50268062715","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063111","type":"CDM"},{"code":"50268063111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268067911","type":"CDM"},{"code":"50268067911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268067915","type":"CDM"},{"code":"50268067915","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068415","type":"CDM"},{"code":"50268068415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068511","type":"CDM"},{"code":"50268068511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068515","type":"CDM"},{"code":"50268068515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068615","type":"CDM"},{"code":"50268068615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068715","type":"CDM"},{"code":"50268068715","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070911","type":"CDM"},{"code":"50268070911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070915","type":"CDM"},{"code":"50268070915","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268071015","type":"CDM"},{"code":"50268071015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268071715","type":"CDM"},{"code":"50268071715","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072215","type":"CDM"},{"code":"50268072215","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072415","type":"CDM"},{"code":"50268072415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072515","type":"CDM"},{"code":"50268072515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072811","type":"CDM"},{"code":"50268072811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072815","type":"CDM"},{"code":"50268072815","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268073011","type":"CDM"},{"code":"50268073011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074115","type":"CDM"},{"code":"50268074115","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074215","type":"CDM"},{"code":"50268074215","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075511","type":"CDM"},{"code":"50268075511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075515","type":"CDM"},{"code":"50268075515","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075812","type":"CDM"},{"code":"50268075812","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075911","type":"CDM"},{"code":"50268075911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075915","type":"CDM"},{"code":"50268075915","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076415","type":"CDM"},{"code":"50268076415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076611","type":"CDM"},{"code":"50268076611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076615","type":"CDM"},{"code":"50268076615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077015","type":"CDM"},{"code":"50268077015","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077213","type":"CDM"},{"code":"50268077213","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268080011","type":"CDM"},{"code":"50268080011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268081615","type":"CDM"},{"code":"50268081615","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383004316","type":"CDM"},{"code":"50383004316","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOCARNITINE TAB 330 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50383017290","type":"CDM"},{"code":"50383017290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383024116","type":"CDM"},{"code":"50383024116","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx50383066730","type":"CDM"},{"code":"50383066730","type":"NDC"}],"standard_charges":[{"gross_charge":47.56,"discounted_cash":16.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML)","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx50383074120","type":"CDM"},{"code":"J7611","type":"HCPCS"},{"code":"50383074120","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL SOLN 50 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383080716","type":"CDM"},{"code":"50383080716","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383082316","type":"CDM"},{"code":"50383082316","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383082416","type":"CDM"},{"code":"50383082416","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RADIUM RA 223 DICHLORIDE INJ 30 MICROCURIE/ML (1100 KBQ/ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50419020801","type":"CDM"},{"code":"A9606","type":"HCPCS"},{"code":"50419020801","type":"NDC"}],"standard_charges":[{"gross_charge":104414.4,"discounted_cash":36545.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOSAN POLYSULFATE SODIUM CAPS 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458009801","type":"CDM"},{"code":"50458009801","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CANAGLIFLOZIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458014030","type":"CDM"},{"code":"50458014030","type":"NDC"}],"standard_charges":[{"gross_charge":10.03,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ITRACONAZOLE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50458029515","type":"CDM"},{"code":"50458029515","type":"NDC"}],"standard_charges":[{"gross_charge":31.44,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458030001","type":"CDM"},{"code":"50458030001","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057701","type":"CDM"},{"code":"50458057701","type":"NDC"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057710","type":"CDM"},{"code":"50458057710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057810","type":"CDM"},{"code":"50458057810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVAROXABAN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057910","type":"CDM"},{"code":"50458057910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058010","type":"CDM"},{"code":"50458058010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458059010","type":"CDM"},{"code":"50458059010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THEOPHYLLINE CAP ER 24HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50474020001","type":"CDM"},{"code":"50474020001","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 8.5 MG/0.85ML","drug_information":{"unit":0.85,"type":"ML"},"code_information":[{"code":"Rx50474063698","type":"CDM"},{"code":"50474063698","type":"NDC"}],"standard_charges":[{"gross_charge":752.08,"discounted_cash":263.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CERTOLIZUMAB PEGOL FOR INJ KIT 2 X 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50474070062","type":"CDM"},{"code":"J0717","type":"HCPCS"},{"code":"50474070062","type":"NDC"}],"standard_charges":[{"gross_charge":53486.04,"discounted_cash":18720.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BRIVARACETAM IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50474097075","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"50474097075","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROZANOLIXIZUMAB-NOLI SUBCUTANEOUS SOLN 280 MG/2ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx50474098079","type":"CDM"},{"code":"J9333","type":"HCPCS"},{"code":"50474098079","type":"NDC"}],"standard_charges":[{"gross_charge":102396.0,"discounted_cash":35838.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COLLAGENASE OINT 250 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx50484001030","type":"CDM"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":388.39,"discounted_cash":135.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RABIES VACCINE, PCEC FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50632001001","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"50632001001","type":"NDC"}],"standard_charges":[{"gross_charge":3190.47,"discounted_cash":1116.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CROTALIDAE POLYVALENT IMMUNE FAB (OVINE) FOR IV INFUSION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633011012","type":"CDM"},{"code":"J0840","type":"HCPCS"},{"code":"50633011012","type":"NDC"}],"standard_charges":[{"gross_charge":13132.16,"discounted_cash":4596.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN IMMUNE FAB FOR INJ 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633012011","type":"CDM"},{"code":"J1162","type":"HCPCS"},{"code":"50633012011","type":"NDC"}],"standard_charges":[{"gross_charge":51079.39,"discounted_cash":17877.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESIPRAMINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742011601","type":"CDM"},{"code":"50742011601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CABERGOLINE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742011808","type":"CDM"},{"code":"J8515","type":"HCPCS"},{"code":"50742011808","type":"NDC"}],"standard_charges":[{"gross_charge":4.01,"discounted_cash":1.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHENAMINE HIPPURATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742014201","type":"CDM"},{"code":"50742014201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742017801","type":"CDM"},{"code":"50742017801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEXILETINE HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742023901","type":"CDM"},{"code":"50742023901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742025801","type":"CDM"},{"code":"50742025801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742026101","type":"CDM"},{"code":"50742026101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742026201","type":"CDM"},{"code":"50742026201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742048401","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"50742048401","type":"NDC"}],"standard_charges":[{"gross_charge":288.8,"discounted_cash":101.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050501","type":"CDM"},{"code":"50742050501","type":"NDC"}],"standard_charges":[{"gross_charge":14.43,"discounted_cash":5.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050510","type":"CDM"},{"code":"50742050510","type":"NDC"}],"standard_charges":[{"gross_charge":9.8,"discounted_cash":3.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050524","type":"CDM"},{"code":"50742050524","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742062201","type":"CDM"},{"code":"50742062201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002001","type":"CDM"},{"code":"51079002001","type":"NDC"}],"standard_charges":[{"gross_charge":22.74,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002003","type":"CDM"},{"code":"51079002003","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002401","type":"CDM"},{"code":"51079002401","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002420","type":"CDM"},{"code":"51079002420","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005120","type":"CDM"},{"code":"51079005120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005801","type":"CDM"},{"code":"51079005801","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005820","type":"CDM"},{"code":"51079005820","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007201","type":"CDM"},{"code":"51079007201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007220","type":"CDM"},{"code":"51079007220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007301","type":"CDM"},{"code":"51079007301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007320","type":"CDM"},{"code":"51079007320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007401","type":"CDM"},{"code":"51079007401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007420","type":"CDM"},{"code":"51079007420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007501","type":"CDM"},{"code":"51079007501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007520","type":"CDM"},{"code":"51079007520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008301","type":"CDM"},{"code":"51079008301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008320","type":"CDM"},{"code":"51079008320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008620","type":"CDM"},{"code":"51079008620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010301","type":"CDM"},{"code":"51079010301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010320","type":"CDM"},{"code":"51079010320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079012801","type":"CDM"},{"code":"51079012801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013101","type":"CDM"},{"code":"51079013101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013120","type":"CDM"},{"code":"51079013120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014101","type":"CDM"},{"code":"51079014101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014120","type":"CDM"},{"code":"51079014120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079015201","type":"CDM"},{"code":"51079015201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079015220","type":"CDM"},{"code":"51079015220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VORICONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016401","type":"CDM"},{"code":"51079016401","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VORICONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016420","type":"CDM"},{"code":"51079016420","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016501","type":"CDM"},{"code":"51079016501","type":"NDC"}],"standard_charges":[{"gross_charge":45.79,"discounted_cash":16.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016520","type":"CDM"},{"code":"51079016520","type":"NDC"}],"standard_charges":[{"gross_charge":37.59,"discounted_cash":13.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018001","type":"CDM"},{"code":"51079018001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018020","type":"CDM"},{"code":"51079018020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019001","type":"CDM"},{"code":"51079019001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019020","type":"CDM"},{"code":"51079019020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019101","type":"CDM"},{"code":"51079019101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019120","type":"CDM"},{"code":"51079019120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020401","type":"CDM"},{"code":"51079020401","type":"NDC"}],"standard_charges":[{"gross_charge":9.88,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020406","type":"CDM"},{"code":"51079020406","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020501","type":"CDM"},{"code":"51079020501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020520","type":"CDM"},{"code":"51079020520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020601","type":"CDM"},{"code":"51079020601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020620","type":"CDM"},{"code":"51079020620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021103","type":"CDM"},{"code":"51079021103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079022401","type":"CDM"},{"code":"51079022401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079024701","type":"CDM"},{"code":"51079024701","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079024720","type":"CDM"},{"code":"51079024720","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079025501","type":"CDM"},{"code":"51079025501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079025520","type":"CDM"},{"code":"51079025520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079027901","type":"CDM"},{"code":"51079027901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079027920","type":"CDM"},{"code":"51079027920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028401","type":"CDM"},{"code":"51079028401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028420","type":"CDM"},{"code":"51079028420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028501","type":"CDM"},{"code":"51079028501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028520","type":"CDM"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028601","type":"CDM"},{"code":"51079028601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028620","type":"CDM"},{"code":"51079028620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029901","type":"CDM"},{"code":"51079029901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029920","type":"CDM"},{"code":"51079029920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037401","type":"CDM"},{"code":"51079037401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037420","type":"CDM"},{"code":"51079037420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037501","type":"CDM"},{"code":"51079037501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037520","type":"CDM"},{"code":"51079037520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038620","type":"CDM"},{"code":"51079038620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041701","type":"CDM"},{"code":"51079041701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041720","type":"CDM"},{"code":"51079041720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041801","type":"CDM"},{"code":"51079041801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041820","type":"CDM"},{"code":"51079041820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043601","type":"CDM"},{"code":"51079043601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043620","type":"CDM"},{"code":"51079043620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043701","type":"CDM"},{"code":"51079043701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043720","type":"CDM"},{"code":"51079043720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044101","type":"CDM"},{"code":"51079044101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044120","type":"CDM"},{"code":"51079044120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044301","type":"CDM"},{"code":"51079044301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044401","type":"CDM"},{"code":"51079044401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045001","type":"CDM"},{"code":"51079045001","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045020","type":"CDM"},{"code":"51079045020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045101","type":"CDM"},{"code":"51079045101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045120","type":"CDM"},{"code":"51079045120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045201","type":"CDM"},{"code":"51079045201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045220","type":"CDM"},{"code":"51079045220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045301","type":"CDM"},{"code":"51079045301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045320","type":"CDM"},{"code":"51079045320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045701","type":"CDM"},{"code":"51079045701","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045720","type":"CDM"},{"code":"51079045720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045801","type":"CDM"},{"code":"51079045801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045820","type":"CDM"},{"code":"51079045820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045901","type":"CDM"},{"code":"51079045901","type":"NDC"}],"standard_charges":[{"gross_charge":7.18,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045920","type":"CDM"},{"code":"51079045920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046001","type":"CDM"},{"code":"51079046001","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046020","type":"CDM"},{"code":"51079046020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046101","type":"CDM"},{"code":"51079046101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046120","type":"CDM"},{"code":"51079046120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046201","type":"CDM"},{"code":"51079046201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046220","type":"CDM"},{"code":"51079046220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046601","type":"CDM"},{"code":"51079046601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046620","type":"CDM"},{"code":"51079046620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079046701","type":"CDM"},{"code":"51079046701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079047401","type":"CDM"},{"code":"51079047401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048001","type":"CDM"},{"code":"51079048001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048020","type":"CDM"},{"code":"51079048020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048201","type":"CDM"},{"code":"51079048201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048220","type":"CDM"},{"code":"51079048220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048501","type":"CDM"},{"code":"51079048501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048520","type":"CDM"},{"code":"51079048520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048701","type":"CDM"},{"code":"51079048701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048720","type":"CDM"},{"code":"51079048720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049801","type":"CDM"},{"code":"51079049801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049820","type":"CDM"},{"code":"51079049820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049901","type":"CDM"},{"code":"51079049901","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049920","type":"CDM"},{"code":"51079049920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054101","type":"CDM"},{"code":"51079054101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054120","type":"CDM"},{"code":"51079054120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054301","type":"CDM"},{"code":"51079054301","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054320","type":"CDM"},{"code":"51079054320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054401","type":"CDM"},{"code":"51079054401","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054420","type":"CDM"},{"code":"51079054420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056101","type":"CDM"},{"code":"51079056101","type":"NDC"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":6.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056103","type":"CDM"},{"code":"51079056103","type":"NDC"}],"standard_charges":[{"gross_charge":13.65,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056201","type":"CDM"},{"code":"51079056201","type":"NDC"}],"standard_charges":[{"gross_charge":24.26,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056203","type":"CDM"},{"code":"51079056203","type":"NDC"}],"standard_charges":[{"gross_charge":24.35,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056501","type":"CDM"},{"code":"51079056501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056520","type":"CDM"},{"code":"51079056520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056601","type":"CDM"},{"code":"51079056601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIORIDAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079056620","type":"CDM"},{"code":"51079056620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIFLUOPERAZINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079057301","type":"CDM"},{"code":"51079057301","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIFLUOPERAZINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079057320","type":"CDM"},{"code":"51079057320","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIFLUOPERAZINE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079057401","type":"CDM"},{"code":"51079057401","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058101","type":"CDM"},{"code":"51079058101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058106","type":"CDM"},{"code":"51079058106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058401","type":"CDM"},{"code":"51079058401","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058420","type":"CDM"},{"code":"51079058420","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058501","type":"CDM"},{"code":"51079058501","type":"NDC"}],"standard_charges":[{"gross_charge":3.24,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058520","type":"CDM"},{"code":"51079058520","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIOTHIXENE CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058801","type":"CDM"},{"code":"51079058801","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THIOTHIXENE CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079058820","type":"CDM"},{"code":"51079058820","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079059801","type":"CDM"},{"code":"51079059801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079059820","type":"CDM"},{"code":"51079059820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062001","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"51079062001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062901","type":"CDM"},{"code":"51079062901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063001","type":"CDM"},{"code":"51079063001","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063020","type":"CDM"},{"code":"51079063020","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079064401","type":"CDM"},{"code":"51079064401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079064420","type":"CDM"},{"code":"51079064420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079065701","type":"CDM"},{"code":"51079065701","type":"NDC"}],"standard_charges":[{"gross_charge":6.46,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079065720","type":"CDM"},{"code":"51079065720","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULINDAC TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079066701","type":"CDM"},{"code":"51079066701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULINDAC TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079066720","type":"CDM"},{"code":"51079066720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079068401","type":"CDM"},{"code":"51079068401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079068420","type":"CDM"},{"code":"51079068420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069001","type":"CDM"},{"code":"51079069001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069020","type":"CDM"},{"code":"51079069020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069203","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"51079069203","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072101","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079072101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072120","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079072120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072201","type":"CDM"},{"code":"51079072201","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072220","type":"CDM"},{"code":"51079072220","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073301","type":"CDM"},{"code":"51079073301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073401","type":"CDM"},{"code":"51079073401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073420","type":"CDM"},{"code":"51079073420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073601","type":"CDM"},{"code":"51079073601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073620","type":"CDM"},{"code":"51079073620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074501","type":"CDM"},{"code":"51079074501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074520","type":"CDM"},{"code":"51079074520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074601","type":"CDM"},{"code":"51079074601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074701","type":"CDM"},{"code":"51079074701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074720","type":"CDM"},{"code":"51079074720","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075301","type":"CDM"},{"code":"51079075301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075320","type":"CDM"},{"code":"51079075320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075901","type":"CDM"},{"code":"51079075901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075920","type":"CDM"},{"code":"51079075920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076701","type":"CDM"},{"code":"51079076701","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076708","type":"CDM"},{"code":"51079076708","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076801","type":"CDM"},{"code":"51079076801","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076820","type":"CDM"},{"code":"51079076820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077101","type":"CDM"},{"code":"51079077101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077120","type":"CDM"},{"code":"51079077120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077401","type":"CDM"},{"code":"51079077401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077601","type":"CDM"},{"code":"51079077601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078201","type":"CDM"},{"code":"51079078201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078220","type":"CDM"},{"code":"51079078220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079001","type":"CDM"},{"code":"51079079001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079020","type":"CDM"},{"code":"51079079020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079601","type":"CDM"},{"code":"51079079601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079620","type":"CDM"},{"code":"51079079620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080201","type":"CDM"},{"code":"51079080201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080220","type":"CDM"},{"code":"51079080220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081001","type":"CDM"},{"code":"51079081001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081020","type":"CDM"},{"code":"51079081020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081201","type":"CDM"},{"code":"51079081201","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NADOLOL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081301","type":"CDM"},{"code":"51079081301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082101","type":"CDM"},{"code":"51079082101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082120","type":"CDM"},{"code":"51079082120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082201","type":"CDM"},{"code":"51079082201","type":"NDC"}],"standard_charges":[{"gross_charge":7.14,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082220","type":"CDM"},{"code":"51079082220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079085201","type":"CDM"},{"code":"51079085201","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079085203","type":"CDM"},{"code":"51079085203","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086401","type":"CDM"},{"code":"51079086401","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086420","type":"CDM"},{"code":"51079086420","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086901","type":"CDM"},{"code":"51079086901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086920","type":"CDM"},{"code":"51079086920","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087001","type":"CDM"},{"code":"51079087001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087020","type":"CDM"},{"code":"51079087020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087101","type":"CDM"},{"code":"51079087101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087120","type":"CDM"},{"code":"51079087120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088101","type":"CDM"},{"code":"51079088101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088120","type":"CDM"},{"code":"51079088120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088201","type":"CDM"},{"code":"51079088201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088220","type":"CDM"},{"code":"51079088220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088620","type":"CDM"},{"code":"51079088620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088801","type":"CDM"},{"code":"51079088801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088820","type":"CDM"},{"code":"51079088820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088901","type":"CDM"},{"code":"51079088901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088920","type":"CDM"},{"code":"51079088920","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089101","type":"CDM"},{"code":"51079089101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089120","type":"CDM"},{"code":"51079089120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089501","type":"CDM"},{"code":"51079089501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089520","type":"CDM"},{"code":"51079089520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089601","type":"CDM"},{"code":"51079089601","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089620","type":"CDM"},{"code":"51079089620","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089901","type":"CDM"},{"code":"51079089901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089920","type":"CDM"},{"code":"51079089920","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079090501","type":"CDM"},{"code":"51079090501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079090520","type":"CDM"},{"code":"51079090520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079091701","type":"CDM"},{"code":"51079091701","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079091720","type":"CDM"},{"code":"51079091720","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092301","type":"CDM"},{"code":"51079092301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092320","type":"CDM"},{"code":"51079092320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092401","type":"CDM"},{"code":"51079092401","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092420","type":"CDM"},{"code":"51079092420","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092801","type":"CDM"},{"code":"51079092801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092820","type":"CDM"},{"code":"51079092820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093001","type":"CDM"},{"code":"51079093001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093020","type":"CDM"},{"code":"51079093020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093101","type":"CDM"},{"code":"51079093101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093120","type":"CDM"},{"code":"51079093120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093201","type":"CDM"},{"code":"51079093201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093220","type":"CDM"},{"code":"51079093220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093501","type":"CDM"},{"code":"51079093501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093520","type":"CDM"},{"code":"51079093520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093601","type":"CDM"},{"code":"51079093601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093620","type":"CDM"},{"code":"51079093620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALENDRONATE SODIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094101","type":"CDM"},{"code":"51079094101","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALENDRONATE SODIUM TAB 70 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094201","type":"CDM"},{"code":"51079094201","type":"NDC"}],"standard_charges":[{"gross_charge":30.69,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094401","type":"CDM"},{"code":"51079094401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094420","type":"CDM"},{"code":"51079094420","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095701","type":"CDM"},{"code":"51079095701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095720","type":"CDM"},{"code":"51079095720","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095801","type":"CDM"},{"code":"51079095801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095820","type":"CDM"},{"code":"51079095820","type":"NDC"}],"standard_charges":[{"gross_charge":4.12,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOVASTATIN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097501","type":"CDM"},{"code":"51079097501","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097801","type":"CDM"},{"code":"51079097801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097820","type":"CDM"},{"code":"51079097820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098101","type":"CDM"},{"code":"51079098101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098120","type":"CDM"},{"code":"51079098120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098201","type":"CDM"},{"code":"51079098201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098220","type":"CDM"},{"code":"51079098220","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098301","type":"CDM"},{"code":"51079098301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098320","type":"CDM"},{"code":"51079098320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098401","type":"CDM"},{"code":"51079098401","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098420","type":"CDM"},{"code":"51079098420","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098501","type":"CDM"},{"code":"51079098501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098520","type":"CDM"},{"code":"51079098520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098601","type":"CDM"},{"code":"51079098601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098620","type":"CDM"},{"code":"51079098620","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099101","type":"CDM"},{"code":"51079099101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099120","type":"CDM"},{"code":"51079099120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099801","type":"CDM"},{"code":"51079099801","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099820","type":"CDM"},{"code":"51079099820","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TISOTUMAB VEDOTIN-TFTV FOR IV SOLUTION 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144000301","type":"CDM"},{"code":"J9273","type":"HCPCS"},{"code":"51144000301","type":"NDC"}],"standard_charges":[{"gross_charge":36819.0,"discounted_cash":12886.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENTERMINE HCL TAB 37.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51224010150","type":"CDM"},{"code":"51224010150","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293061201","type":"CDM"},{"code":"51293061201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293081001","type":"CDM"},{"code":"51293081001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEG 3350-KCL-SOD BICARB-NACL FOR SOLN 420 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx51525683104","type":"CDM"},{"code":"51525683104","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETIC ACID SOLN 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51552005503","type":"CDM"},{"code":"51552005503","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125301","type":"CDM"},{"code":"51672125301","type":"NDC"}],"standard_charges":[{"gross_charge":29.72,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672125302","type":"CDM"},{"code":"51672125302","type":"NDC"}],"standard_charges":[{"gross_charge":59.49,"discounted_cash":20.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125801","type":"CDM"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":13.74,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125901","type":"CDM"},{"code":"51672125901","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672126401","type":"CDM"},{"code":"51672126401","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672127201","type":"CDM"},{"code":"51672127201","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx51672127203","type":"CDM"},{"code":"51672127203","type":"NDC"}],"standard_charges":[{"gross_charge":55.17,"discounted_cash":19.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOCONAZOLE CREAM 2%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672129802","type":"CDM"},{"code":"51672129802","type":"NDC"}],"standard_charges":[{"gross_charge":53.05,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ECONAZOLE NITRATE CREAM 1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672130301","type":"CDM"},{"code":"51672130301","type":"NDC"}],"standard_charges":[{"gross_charge":34.92,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx51672131200","type":"CDM"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":2.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672131201","type":"CDM"},{"code":"51672131201","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672138601","type":"CDM"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":16.87,"discounted_cash":5.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400101","type":"CDM"},{"code":"51672400101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400205","type":"CDM"},{"code":"51672400205","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOMIPRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672401105","type":"CDM"},{"code":"51672401105","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETODOLAC TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672401801","type":"CDM"},{"code":"51672401801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672402504","type":"CDM"},{"code":"51672402504","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51672404709","type":"CDM"},{"code":"51672404709","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672404801","type":"CDM"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"gross_charge":23.51,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51672406901","type":"CDM"},{"code":"51672406901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672411101","type":"CDM"},{"code":"51672411101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672413001","type":"CDM"},{"code":"51672413001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672413101","type":"CDM"},{"code":"51672413101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx51754010803","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"51754010803","type":"NDC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx51754200104","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754200104","type":"NDC"}],"standard_charges":[{"gross_charge":97.47,"discounted_cash":34.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51754501204","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754501204","type":"NDC"}],"standard_charges":[{"gross_charge":98.57,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862027301","type":"CDM"},{"code":"51862027301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862032001","type":"CDM"},{"code":"51862032001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862032101","type":"CDM"},{"code":"51862032101","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862044630","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"51862044630","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx51991006498","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"51991006498","type":"NDC"}],"standard_charges":[{"gross_charge":1388.52,"discounted_cash":485.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51991014417","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"51991014417","type":"NDC"}],"standard_charges":[{"gross_charge":168.86,"discounted_cash":59.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51991014499","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"51991014499","type":"NDC"}],"standard_charges":[{"gross_charge":132.27,"discounted_cash":46.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991029201","type":"CDM"},{"code":"51991029201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXCARBAZEPINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991029301","type":"CDM"},{"code":"51991029301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBINAFINE HCL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991052633","type":"CDM"},{"code":"51991052633","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FE FUMARATE W/ B12-VIT C-FA-IFC CAP 110-0.015-75-0.5-240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991063501","type":"CDM"},{"code":"51991063501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991075933","type":"CDM"},{"code":"51991075933","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51991098317","type":"CDM"},{"code":"51991098317","type":"NDC"}],"standard_charges":[{"gross_charge":96.64,"discounted_cash":33.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51991098399","type":"CDM"},{"code":"51991098399","type":"NDC"}],"standard_charges":[{"gross_charge":100.74,"discounted_cash":35.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TELAVANCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52118000101","type":"CDM"},{"code":"J3095","type":"HCPCS"},{"code":"52118000101","type":"NDC"}],"standard_charges":[{"gross_charge":3927.61,"discounted_cash":1374.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THEOPHYLLINE CAP ER 24HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52244020010","type":"CDM"},{"code":"52244020010","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx52268010001","type":"CDM"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEG 3350-KCL-SOD BICARB-NACL FOR SOLN 420 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx52268030201","type":"CDM"},{"code":"52268030201","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEG 3350-KCL-SOD BICARB-NACL FOR SOLN 420 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx52268040001","type":"CDM"},{"code":"52268040001","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx52536010810","type":"CDM"},{"code":"52536010810","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORGESTREL & ETHINYL ESTRADIOL TAB 0.3 MG-30 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544084728","type":"CDM"},{"code":"52544084728","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ASPIRIN-CAFF W/ CODEINE CAP 50-325-40-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52544095601","type":"CDM"},{"code":"52544095601","type":"NDC"}],"standard_charges":[{"gross_charge":15.84,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ECONAZOLE NITRATE CREAM 1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx52565002215","type":"CDM"},{"code":"52565002215","type":"NDC"}],"standard_charges":[{"gross_charge":17.32,"discounted_cash":6.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOPIRAMATE ORAL SOLN 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx52652900101","type":"CDM"},{"code":"52652900101","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817018010","type":"CDM"},{"code":"52817018010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817021010","type":"CDM"},{"code":"52817021010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817027030","type":"CDM"},{"code":"52817027030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817036210","type":"CDM"},{"code":"52817036210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53014053007","type":"CDM"},{"code":"53014053007","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53014053107","type":"CDM"},{"code":"53014053107","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489011802","type":"CDM"},{"code":"53489011802","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489038601","type":"CDM"},{"code":"53489038601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOXIDIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489038701","type":"CDM"},{"code":"53489038701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULINDAC TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489047801","type":"CDM"},{"code":"53489047801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPAFENONE HCL TAB 225 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489055201","type":"CDM"},{"code":"53489055201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746017901","type":"CDM"},{"code":"53746017901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746018801","type":"CDM"},{"code":"53746018801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746019001","type":"CDM"},{"code":"53746019001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 400-80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746027101","type":"CDM"},{"code":"53746027101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746027201","type":"CDM"},{"code":"53746027201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746051101","type":"CDM"},{"code":"53746051101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746051401","type":"CDM"},{"code":"53746051401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746054401","type":"CDM"},{"code":"53746054401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746054501","type":"CDM"},{"code":"53746054501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746064101","type":"CDM"},{"code":"53746064101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746074501","type":"CDM"},{"code":"53746074501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE CAP ER 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092018981","type":"CDM"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092039101","type":"CDM"},{"code":"54092039101","type":"NDC"}],"standard_charges":[{"gross_charge":9.79,"discounted_cash":3.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx54288010310","type":"CDM"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":94.85,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEHYDRATED ALCOHOL INTRA-ARTERIAL SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54288010502","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288010502","type":"NDC"}],"standard_charges":[{"gross_charge":8512.67,"discounted_cash":2979.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEHYDRATED ALCOHOL INTRA-ARTERIAL SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54288010515","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288010515","type":"NDC"}],"standard_charges":[{"gross_charge":4525.69,"discounted_cash":1583.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TETRACAINE HCL INJ 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx54288012710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288012710","type":"NDC"}],"standard_charges":[{"gross_charge":384.98,"discounted_cash":134.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54288014201","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"54288014201","type":"NDC"}],"standard_charges":[{"gross_charge":102.95,"discounted_cash":36.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAPAVERINE HCL INJ 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54288014210","type":"CDM"},{"code":"J2440","type":"HCPCS"},{"code":"54288014210","type":"NDC"}],"standard_charges":[{"gross_charge":101.04,"discounted_cash":35.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOCARNITINE INJ 200 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54482014701","type":"CDM"},{"code":"J1955","type":"HCPCS"},{"code":"54482014701","type":"NDC"}],"standard_charges":[{"gross_charge":399.05,"discounted_cash":139.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54505033210","type":"CDM"},{"code":"54505033210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54569579500","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"54569579500","type":"NDC"}],"standard_charges":[{"gross_charge":95.25,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54643564601","type":"CDM"},{"code":"54643564601","type":"NDC"}],"standard_charges":[{"gross_charge":177.24,"discounted_cash":62.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MULTIPLE VITAMIN IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54643564901","type":"CDM"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"gross_charge":97.9,"discounted_cash":34.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx54838050140","type":"CDM"},{"code":"54838050140","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THEOPHYLLINE SOLN 80 MG/15ML","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx54838055680","type":"CDM"},{"code":"54838055680","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54879000201","type":"CDM"},{"code":"54879000201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111012490","type":"CDM"},{"code":"55111012490","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111019605","type":"CDM"},{"code":"55111019605","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111019690","type":"CDM"},{"code":"55111019690","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111025660","type":"CDM"},{"code":"55111025660","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111026281","type":"CDM"},{"code":"55111026281","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111032001","type":"CDM"},{"code":"55111032001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111035260","type":"CDM"},{"code":"55111035260","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111035360","type":"CDM"},{"code":"55111035360","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111052701","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"55111052701","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111055610","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"55111055610","type":"NDC"}],"standard_charges":[{"gross_charge":719.1,"discounted_cash":251.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068010","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068010","type":"NDC"}],"standard_charges":[{"gross_charge":321.6,"discounted_cash":112.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55111068507","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"55111068507","type":"NDC"}],"standard_charges":[{"gross_charge":98.85,"discounted_cash":34.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55111068852","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":502.28,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111073001","type":"CDM"},{"code":"55111073001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111073390","type":"CDM"},{"code":"55111073390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111079630","type":"CDM"},{"code":"55111079630","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011110","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011110","type":"NDC"}],"standard_charges":[{"gross_charge":93.83,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011310","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"gross_charge":94.49,"discounted_cash":33.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011420","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"gross_charge":95.51,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011601","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011601","type":"NDC"}],"standard_charges":[{"gross_charge":94.57,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011620","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011930","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":33.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012030","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":95.07,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012150","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"gross_charge":95.53,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012315","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"55150012315","type":"NDC"}],"standard_charges":[{"gross_charge":97.41,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012824","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"55150012824","type":"NDC"}],"standard_charges":[{"gross_charge":98.05,"discounted_cash":34.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150015410","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015410","type":"NDC"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILDENAFIL CITRATE IV SOLN 10 MG/12.5ML (BASE EQUIVALENT)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx55150016613","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150016613","type":"NDC"}],"standard_charges":[{"gross_charge":1244.74,"discounted_cash":435.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016710","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016710","type":"NDC"}],"standard_charges":[{"gross_charge":93.89,"discounted_cash":32.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016830","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017030","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":93.48,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017230","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017230","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150017301","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"gross_charge":96.76,"discounted_cash":33.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017705","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx55150019301","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"55150019301","type":"NDC"}],"standard_charges":[{"gross_charge":189.16,"discounted_cash":66.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150019410","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":95.77,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150019720","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150019720","type":"NDC"}],"standard_charges":[{"gross_charge":93.74,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150020010","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150020010","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150020120","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150020120","type":"NDC"}],"standard_charges":[{"gross_charge":94.38,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020210","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"gross_charge":94.51,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"gross_charge":96.57,"discounted_cash":33.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATRACURIUM BESYLATE PRESERVATIVE FREE (PF) IV SOLN 50 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150021605","type":"CDM"},{"code":"55150021605","type":"NDC"}],"standard_charges":[{"gross_charge":94.99,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150022110","type":"CDM"},{"code":"55150022110","type":"NDC"}],"standard_charges":[{"gross_charge":94.45,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150023110","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023110","type":"NDC"}],"standard_charges":[{"gross_charge":163.24,"discounted_cash":57.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55150023210","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023210","type":"NDC"}],"standard_charges":[{"gross_charge":100.82,"discounted_cash":35.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55150023310","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023310","type":"NDC"}],"standard_charges":[{"gross_charge":102.87,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023410","type":"CDM"},{"code":"55150023410","type":"NDC"}],"standard_charges":[{"gross_charge":96.36,"discounted_cash":33.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 120 MG/30ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150023930","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150023930","type":"NDC"}],"standard_charges":[{"gross_charge":93.39,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARGATROBAN IN SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx55150024101","type":"CDM"},{"code":"J0898","type":"HCPCS"},{"code":"55150024101","type":"NDC"}],"standard_charges":[{"gross_charge":780.1,"discounted_cash":273.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 500 MG/2.5ML (200 MG/ML)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx55150027099","type":"CDM"},{"code":"J9071","type":"HCPCS"},{"code":"55150027099","type":"NDC"}],"standard_charges":[{"gross_charge":665.99,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 1 GM/5ML (200 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150027199","type":"CDM"},{"code":"J9071","type":"HCPCS"},{"code":"55150027199","type":"NDC"}],"standard_charges":[{"gross_charge":1226.89,"discounted_cash":429.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150028220","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"gross_charge":264.24,"discounted_cash":92.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029701","type":"CDM"},{"code":"55150029701","type":"NDC"}],"standard_charges":[{"gross_charge":383.96,"discounted_cash":134.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029710","type":"CDM"},{"code":"55150029710","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx55150030401","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030401","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx55150030701","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"55150030701","type":"NDC"}],"standard_charges":[{"gross_charge":96.63,"discounted_cash":33.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx55150033501","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"55150033501","type":"NDC"}],"standard_charges":[{"gross_charge":376.48,"discounted_cash":131.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150040225","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"gross_charge":94.81,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150042501","type":"NDC"}],"standard_charges":[{"gross_charge":94.64,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150042510","type":"NDC"}],"standard_charges":[{"gross_charge":94.38,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150043801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043801","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150043810","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043810","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150047101","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"55150047101","type":"NDC"}],"standard_charges":[{"gross_charge":181.66,"discounted_cash":63.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55154668307","type":"CDM"},{"code":"55154668307","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55253080130","type":"CDM"},{"code":"55253080130","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":2.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55253080290","type":"CDM"},{"code":"55253080290","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55390005210","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"55390005210","type":"NDC"}],"standard_charges":[{"gross_charge":285.99,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55390005401","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"55390005401","type":"NDC"}],"standard_charges":[{"gross_charge":414.45,"discounted_cash":145.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx55390035703","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"55390035703","type":"NDC"}],"standard_charges":[{"gross_charge":209.56,"discounted_cash":73.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TARLATAMAB-DLLE FOR IV INFUSION 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513005901","type":"CDM"},{"code":"J9026","type":"HCPCS"},{"code":"55513005901","type":"NDC"}],"standard_charges":[{"gross_charge":15475.4,"discounted_cash":5416.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513007330","type":"CDM"},{"code":"55513007330","type":"NDC"}],"standard_charges":[{"gross_charge":24.04,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TARLATAMAB-DLLE FOR IV INFUSION 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513010301","type":"CDM"},{"code":"J9026","type":"HCPCS"},{"code":"55513010301","type":"NDC"}],"standard_charges":[{"gross_charge":15475.4,"discounted_cash":5416.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEZEPELUMAB-EKKO SUBCUTANEOUS SOLN PREF SYR 210 MG/1.91ML","drug_information":{"unit":1.91,"type":"ML"},"code_information":[{"code":"Rx55513011201","type":"CDM"},{"code":"J2356","type":"HCPCS"},{"code":"55513011201","type":"NDC"}],"standard_charges":[{"gross_charge":48682.82,"discounted_cash":17038.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"APREMILAST TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513013760","type":"CDM"},{"code":"55513013760","type":"NDC"}],"standard_charges":[{"gross_charge":121.99,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BEVACIZUMAB-AWWB IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx55513020601","type":"CDM"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":6558.19,"discounted_cash":2295.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BEVACIZUMAB-AWWB IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx55513020701","type":"CDM"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":25924.5,"discounted_cash":9073.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 250 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022101","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":30676.57,"discounted_cash":10736.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022301","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"gross_charge":15338.51,"discounted_cash":5368.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071021","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":19259.29,"discounted_cash":6740.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DENOSUMAB INJ 120 MG/1.7ML","drug_information":{"unit":1.7,"type":"ML"},"code_information":[{"code":"Rx55513073001","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":35422.79,"discounted_cash":12397.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513088002","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"gross_charge":29293.83,"discounted_cash":10252.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55513092491","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513092491","type":"NDC"}],"standard_charges":[{"gross_charge":3422.38,"discounted_cash":1197.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55566210002","type":"CDM"},{"code":"55566210002","type":"NDC"}],"standard_charges":[{"gross_charge":6.79,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55566506001","type":"CDM"},{"code":"55566506001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237000511","type":"CDM"},{"code":"57237000511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237000630","type":"CDM"},{"code":"57237000630","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001760","type":"CDM"},{"code":"57237001760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001830","type":"CDM"},{"code":"57237001830","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001890","type":"CDM"},{"code":"57237001890","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001930","type":"CDM"},{"code":"57237001930","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237004290","type":"CDM"},{"code":"57237004290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237004701","type":"CDM"},{"code":"57237004701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE FOR SUSP 10 MG/ML","drug_information":{"unit":35.0,"type":"ML"},"code_information":[{"code":"Rx57237014935","type":"CDM"},{"code":"57237014935","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE FOR SUSP 40 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx57237015035","type":"CDM"},{"code":"57237015035","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REPAGLINIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237015801","type":"CDM"},{"code":"57237015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OMEPRAZOLE CAP DELAYED RELEASE 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237016199","type":"CDM"},{"code":"57237016199","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017301","type":"CDM"},{"code":"57237017301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017401","type":"CDM"},{"code":"57237017401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017501","type":"CDM"},{"code":"57237017501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237018290","type":"CDM"},{"code":"57237018290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237021990","type":"CDM"},{"code":"57237021990","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237022030","type":"CDM"},{"code":"57237022030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237022090","type":"CDM"},{"code":"57237022090","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMIVUDINE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx57237027424","type":"CDM"},{"code":"57237027424","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664022888","type":"CDM"},{"code":"57664022888","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664022988","type":"CDM"},{"code":"57664022988","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664037708","type":"CDM"},{"code":"57664037708","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664050652","type":"CDM"},{"code":"57664050652","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664064888","type":"CDM"},{"code":"57664064888","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHOTERICIN B LIPID INJ SUSP (FOR IV INFUSION) 5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57665010141","type":"CDM"},{"code":"J0287","type":"HCPCS"},{"code":"57665010141","type":"NDC"}],"standard_charges":[{"gross_charge":1077.88,"discounted_cash":377.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENTERMINE HCL TAB 37.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57844000901","type":"CDM"},{"code":"57844000901","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INFLIXIMAB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57894003001","type":"CDM"},{"code":"J1745","type":"HCPCS"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":11986.68,"discounted_cash":4195.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GOLIMUMAB IV SOLN 50 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx57894035001","type":"CDM"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":20513.24,"discounted_cash":7179.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx57894050205","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050205","type":"NDC"}],"standard_charges":[{"gross_charge":8051.67,"discounted_cash":2818.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57894050220","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050220","type":"NDC"}],"standard_charges":[{"gross_charge":30246.63,"discounted_cash":10586.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx57894050505","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050505","type":"NDC"}],"standard_charges":[{"gross_charge":8011.91,"discounted_cash":2804.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57894050520","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050520","type":"NDC"}],"standard_charges":[{"gross_charge":31739.51,"discounted_cash":11108.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VAC FOR INJ 10 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58160072615","type":"CDM"},{"code":"90648","type":"HCPCS"},{"code":"58160072615","type":"NDC"}],"standard_charges":[{"gross_charge":126.76,"discounted_cash":44.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPH-TET TOX-ACELL PERT-HEP B-POLIO IPV VAC SUSP PREF SYR","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160081152","type":"CDM"},{"code":"90723","type":"HCPCS"},{"code":"58160081152","type":"NDC"}],"standard_charges":[{"gross_charge":739.19,"discounted_cash":258.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VAC FOR INJ 10 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58160081811","type":"CDM"},{"code":"90648","type":"HCPCS"},{"code":"58160081811","type":"NDC"}],"standard_charges":[{"gross_charge":130.98,"discounted_cash":45.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082052","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":212.64,"discounted_cash":74.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082052","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":425.28,"discounted_cash":148.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOSTER VAC RECOMBINANT ADJUVANTED FOR IM INJ 50 MCG/0.5ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58160082311","type":"CDM"},{"code":"90750","type":"HCPCS"},{"code":"58160082311","type":"NDC"}],"standard_charges":[{"gross_charge":2058.19,"discounted_cash":720.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082652","type":"CDM"},{"code":"90632","type":"HCPCS"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"gross_charge":774.15,"discounted_cash":270.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084252","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":400.99,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RABIES VACCINE, PCEC FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58160096412","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"58160096412","type":"NDC"}],"standard_charges":[{"gross_charge":3335.55,"discounted_cash":1167.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THYROTROPIN ALFA FOR INJ 0.9 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468003002","type":"CDM"},{"code":"J3240","type":"HCPCS"},{"code":"58468003002","type":"NDC"}],"standard_charges":[{"gross_charge":19880.33,"discounted_cash":6958.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx58914008052","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"58914008052","type":"NDC"}],"standard_charges":[{"gross_charge":862.93,"discounted_cash":302.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58914050156","type":"CDM"},{"code":"58914050156","type":"NDC"}],"standard_charges":[{"gross_charge":53.24,"discounted_cash":18.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BALSAM PERU-CASTOR OIL OINT","drug_information":{"unit":56.7,"type":"GM"},"code_information":[{"code":"Rx58980078021","type":"CDM"},{"code":"58980078021","type":"NDC"}],"standard_charges":[{"gross_charge":30.95,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041010","type":"CDM"},{"code":"59011041010","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041020","type":"CDM"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011042010","type":"CDM"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011042020","type":"CDM"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011044010","type":"CDM"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011044020","type":"CDM"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"gross_charge":20.91,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000613","type":"CDM"},{"code":"59148000613","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":9.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000735","type":"CDM"},{"code":"59148000735","type":"NDC"}],"standard_charges":[{"gross_charge":41.74,"discounted_cash":14.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOLVAPTAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148002050","type":"CDM"},{"code":"59148002050","type":"NDC"}],"standard_charges":[{"gross_charge":776.39,"discounted_cash":271.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOLVAPTAN TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148002150","type":"CDM"},{"code":"59148002150","type":"NDC"}],"standard_charges":[{"gross_charge":805.41,"discounted_cash":281.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN W/ BENOXINATE OPHTH SOLN 0.25-0.4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx59390021805","type":"CDM"},{"code":"59390021805","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INTERFERON BETA-1A IM PREFILLED SYRINGE KIT 30 MCG/0.5ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59627000205","type":"CDM"},{"code":"Q3027","type":"HCPCS"},{"code":"59627000205","type":"NDC"}],"standard_charges":[{"gross_charge":12507.8,"discounted_cash":4377.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INTERFERON BETA-1A IM AUTO-INJECTOR KIT 30 MCG/0.5ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59627000304","type":"CDM"},{"code":"Q3027","type":"HCPCS"},{"code":"59627000304","type":"NDC"}],"standard_charges":[{"gross_charge":50031.18,"discounted_cash":17510.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROGESTERONE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651015201","type":"CDM"},{"code":"59651015201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651029960","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"59651029960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651048401","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"59651048401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DARUNAVIR TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59676056201","type":"CDM"},{"code":"59676056201","type":"NDC"}],"standard_charges":[{"gross_charge":49.45,"discounted_cash":17.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DARUNAVIR TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59676056630","type":"CDM"},{"code":"59676056630","type":"NDC"}],"standard_charges":[{"gross_charge":98.9,"discounted_cash":34.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746017106","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"59746017106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746030612","type":"CDM"},{"code":"59746030612","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746032990","type":"CDM"},{"code":"59746032990","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746036030","type":"CDM"},{"code":"59746036030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746038306","type":"CDM"},{"code":"59746038306","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHENAMINE HIPPURATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746079701","type":"CDM"},{"code":"59746079701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762003301","type":"CDM"},{"code":"59762003301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762007401","type":"CDM"},{"code":"59762007401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762015701","type":"CDM"},{"code":"59762015701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762015801","type":"CDM"},{"code":"59762015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762018001","type":"CDM"},{"code":"59762018001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762018003","type":"CDM"},{"code":"59762018003","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CABERGOLINE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762100501","type":"CDM"},{"code":"J8515","type":"HCPCS"},{"code":"59762100501","type":"NDC"}],"standard_charges":[{"gross_charge":8.15,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762120601","type":"CDM"},{"code":"59762120601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762153005","type":"CDM"},{"code":"59762153005","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762153006","type":"CDM"},{"code":"59762153006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762153701","type":"CDM"},{"code":"59762153701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762154004","type":"CDM"},{"code":"59762154004","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762154005","type":"CDM"},{"code":"59762154005","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762330401","type":"CDM"},{"code":"59762330401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762330403","type":"CDM"},{"code":"59762330403","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762372101","type":"CDM"},{"code":"59762372101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE SOLN 1%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx59762372801","type":"CDM"},{"code":"59762372801","type":"NDC"}],"standard_charges":[{"gross_charge":45.04,"discounted_cash":15.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762374001","type":"CDM"},{"code":"59762374001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762374202","type":"CDM"},{"code":"59762374202","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59762453701","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"59762453701","type":"NDC"}],"standard_charges":[{"gross_charge":254.12,"discounted_cash":88.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59762453702","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"59762453702","type":"NDC"}],"standard_charges":[{"gross_charge":212.53,"discounted_cash":74.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762490004","type":"CDM"},{"code":"59762490004","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762491003","type":"CDM"},{"code":"59762491003","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500002","type":"CDM"},{"code":"59762500002","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500005","type":"CDM"},{"code":"59762500005","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762531001","type":"CDM"},{"code":"59762531001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762669108","type":"CDM"},{"code":"59762669108","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762669208","type":"CDM"},{"code":"59762669208","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60219107601","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"60219107601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx60219174802","type":"CDM"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CITRATE & CITRIC ACID SOLN 1100-334 MG/5ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx60258000316","type":"CDM"},{"code":"60258000316","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM THIOSULFATE IV SOLN 250 MG/ML (25%)","drug_information":{"unit":1.6,"type":"ML"},"code_information":[{"code":"Rx60267070550","type":"CDM"},{"code":"J0209","type":"HCPCS"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"gross_charge":95.87,"discounted_cash":33.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432006575","type":"CDM"},{"code":"60432006575","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE SOLUTION 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60432009216","type":"CDM"},{"code":"60432009216","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60432012916","type":"CDM"},{"code":"60432012916","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx60432013108","type":"CDM"},{"code":"60432013108","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL SYRUP 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60432015004","type":"CDM"},{"code":"60432015004","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432021208","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"60432021208","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432045516","type":"CDM"},{"code":"60432045516","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432053760","type":"CDM"},{"code":"60432053760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60432065104","type":"CDM"},{"code":"60432065104","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505003306","type":"CDM"},{"code":"60505003306","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETODOLAC TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505004101","type":"CDM"},{"code":"60505004101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SELEGILINE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505005501","type":"CDM"},{"code":"60505005501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505008000","type":"CDM"},{"code":"60505008000","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505013400","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"60505013400","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505014100","type":"CDM"},{"code":"60505014100","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505015701","type":"CDM"},{"code":"60505015701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505015900","type":"CDM"},{"code":"60505015900","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL ORAL SUSP 10 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505040205","type":"CDM"},{"code":"60505040205","type":"NDC"}],"standard_charges":[{"gross_charge":12.16,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505059701","type":"CDM"},{"code":"60505059701","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505074905","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505074905","type":"NDC"}],"standard_charges":[{"gross_charge":94.58,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505075004","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505075004","type":"NDC"}],"standard_charges":[{"gross_charge":94.98,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505075204","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505075204","type":"NDC"}],"standard_charges":[{"gross_charge":96.51,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505075304","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505075304","type":"NDC"}],"standard_charges":[{"gross_charge":98.85,"discounted_cash":34.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505075905","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"60505075905","type":"NDC"}],"standard_charges":[{"gross_charge":99.8,"discounted_cash":34.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx60505079600","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079600","type":"NDC"}],"standard_charges":[{"gross_charge":172.27,"discounted_cash":60.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx60505079800","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079800","type":"NDC"}],"standard_charges":[{"gross_charge":203.48,"discounted_cash":71.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01%","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx60505081500","type":"CDM"},{"code":"60505081500","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx60505082306","type":"CDM"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":102.94,"discounted_cash":36.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505083400","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505083400","type":"NDC"}],"standard_charges":[{"gross_charge":99.9,"discounted_cash":34.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505083404","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505083404","type":"NDC"}],"standard_charges":[{"gross_charge":99.89,"discounted_cash":34.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505100301","type":"CDM"},{"code":"60505100301","type":"NDC"}],"standard_charges":[{"gross_charge":44.08,"discounted_cash":15.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505100302","type":"CDM"},{"code":"60505100302","type":"NDC"}],"standard_charges":[{"gross_charge":88.15,"discounted_cash":30.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEFLUNOMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505250301","type":"CDM"},{"code":"60505250301","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CILOSTAZOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505252101","type":"CDM"},{"code":"60505252101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BALSALAZIDE DISODIUM CAP 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505257507","type":"CDM"},{"code":"60505257507","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505267303","type":"CDM"},{"code":"60505267303","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE CAP ER 12HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505280707","type":"CDM"},{"code":"60505280707","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505299506","type":"CDM"},{"code":"60505299506","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505299603","type":"CDM"},{"code":"60505299603","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505299703","type":"CDM"},{"code":"60505299703","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505311000","type":"CDM"},{"code":"60505311000","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMIVUDINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505325106","type":"CDM"},{"code":"60505325106","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505327500","type":"CDM"},{"code":"60505327500","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505357409","type":"CDM"},{"code":"60505357409","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505387709","type":"CDM"},{"code":"60505387709","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRASUGREL HCL TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505464303","type":"CDM"},{"code":"60505464303","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx60505607800","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"60505607800","type":"NDC"}],"standard_charges":[{"gross_charge":135.01,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx60505607900","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"60505607900","type":"NDC"}],"standard_charges":[{"gross_charge":599.42,"discounted_cash":209.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx60505607904","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"60505607904","type":"NDC"}],"standard_charges":[{"gross_charge":380.71,"discounted_cash":133.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx60505608000","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"60505608000","type":"NDC"}],"standard_charges":[{"gross_charge":599.42,"discounted_cash":209.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx60505608100","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"60505608100","type":"NDC"}],"standard_charges":[{"gross_charge":431.95,"discounted_cash":151.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505610204","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505610204","type":"NDC"}],"standard_charges":[{"gross_charge":94.74,"discounted_cash":33.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REGADENOSON IV INJ 0.4 MG/5ML (0.08 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505611600","type":"CDM"},{"code":"J2785","type":"HCPCS"},{"code":"60505611600","type":"NDC"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":35.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505612801","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"gross_charge":285.39,"discounted_cash":99.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60505613000","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"60505613000","type":"NDC"}],"standard_charges":[{"gross_charge":93.55,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60505613005","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505613206","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"60505613206","type":"NDC"}],"standard_charges":[{"gross_charge":264.83,"discounted_cash":92.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx60505613207","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"60505613207","type":"NDC"}],"standard_charges":[{"gross_charge":288.14,"discounted_cash":100.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614604","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"gross_charge":95.51,"discounted_cash":33.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614704","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"gross_charge":97.49,"discounted_cash":34.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614900","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505614900","type":"NDC"}],"standard_charges":[{"gross_charge":97.42,"discounted_cash":34.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615700","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615700","type":"NDC"}],"standard_charges":[{"gross_charge":96.13,"discounted_cash":33.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615704","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":95.68,"discounted_cash":33.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615904","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":97.52,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505616900","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"60505616900","type":"NDC"}],"standard_charges":[{"gross_charge":98.43,"discounted_cash":34.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505616901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"60505616901","type":"NDC"}],"standard_charges":[{"gross_charge":6.21,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"},{"gross_charge":97.39,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623100","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623100","type":"NDC"}],"standard_charges":[{"gross_charge":97.29,"discounted_cash":34.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623105","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":97.29,"discounted_cash":34.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623600","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"60505623600","type":"NDC"}],"standard_charges":[{"gross_charge":102.78,"discounted_cash":35.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623606","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"60505623606","type":"NDC"}],"standard_charges":[{"gross_charge":102.71,"discounted_cash":35.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700200","type":"CDM"},{"code":"60505700200","type":"NDC"}],"standard_charges":[{"gross_charge":13.76,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700400","type":"CDM"},{"code":"60505700400","type":"NDC"}],"standard_charges":[{"gross_charge":27.78,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700402","type":"CDM"},{"code":"60505700402","type":"NDC"}],"standard_charges":[{"gross_charge":27.91,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700600","type":"CDM"},{"code":"60505700600","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700700","type":"CDM"},{"code":"60505700700","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700702","type":"CDM"},{"code":"60505700702","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700800","type":"CDM"},{"code":"60505700800","type":"NDC"}],"standard_charges":[{"gross_charge":9.23,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700802","type":"CDM"},{"code":"60505700802","type":"NDC"}],"standard_charges":[{"gross_charge":9.23,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700900","type":"CDM"},{"code":"60505700900","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700902","type":"CDM"},{"code":"60505700902","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PALIVIZUMAB IM SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60574411301","type":"CDM"},{"code":"90378","type":"HCPCS"},{"code":"60574411301","type":"NDC"}],"standard_charges":[{"gross_charge":34263.93,"discounted_cash":11992.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PALIVIZUMAB IM SOLN 50 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx60574411401","type":"CDM"},{"code":"90378","type":"HCPCS"},{"code":"60574411401","type":"NDC"}],"standard_charges":[{"gross_charge":20289.47,"discounted_cash":7101.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687010521","type":"CDM"},{"code":"60687010521","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011301","type":"CDM"},{"code":"60687011301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012201","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012211","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012401","type":"CDM"},{"code":"60687012401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012411","type":"CDM"},{"code":"60687012411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687013401","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687013401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014501","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014511","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015625","type":"CDM"},{"code":"60687015625","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015695","type":"CDM"},{"code":"60687015695","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015811","type":"CDM"},{"code":"60687015811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016301","type":"CDM"},{"code":"60687016301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016311","type":"CDM"},{"code":"60687016311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687018811","type":"CDM"},{"code":"60687018811","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687018821","type":"CDM"},{"code":"60687018821","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019011","type":"CDM"},{"code":"60687019011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019501","type":"CDM"},{"code":"60687019501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019911","type":"CDM"},{"code":"60687019911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020601","type":"CDM"},{"code":"60687020601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020611","type":"CDM"},{"code":"60687020611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021501","type":"CDM"},{"code":"60687021501","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021701","type":"CDM"},{"code":"60687021701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022901","type":"CDM"},{"code":"60687022901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024201","type":"CDM"},{"code":"60687024201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx60687027566","type":"CDM"},{"code":"60687027566","type":"NDC"}],"standard_charges":[{"gross_charge":7.71,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029301","type":"CDM"},{"code":"60687029301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029311","type":"CDM"},{"code":"60687029311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ITRACONAZOLE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029925","type":"CDM"},{"code":"60687029925","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ITRACONAZOLE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029995","type":"CDM"},{"code":"60687029995","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030421","type":"CDM"},{"code":"60687030421","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032701","type":"CDM"},{"code":"60687032701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032711","type":"CDM"},{"code":"60687032711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687033301","type":"CDM"},{"code":"60687033301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034501","type":"CDM"},{"code":"60687034501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034611","type":"CDM"},{"code":"60687034611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037411","type":"CDM"},{"code":"60687037411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037521","type":"CDM"},{"code":"60687037521","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037701","type":"CDM"},{"code":"60687037701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037711","type":"CDM"},{"code":"60687037711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038411","type":"CDM"},{"code":"60687038411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038801","type":"CDM"},{"code":"60687038801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038811","type":"CDM"},{"code":"60687038811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60687039483","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"60687039483","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040211","type":"CDM"},{"code":"60687040211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60687041771","type":"CDM"},{"code":"60687041771","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041801","type":"CDM"},{"code":"60687041801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041811","type":"CDM"},{"code":"60687041811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687042411","type":"CDM"},{"code":"60687042411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043301","type":"CDM"},{"code":"60687043301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043901","type":"CDM"},{"code":"60687043901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043911","type":"CDM"},{"code":"60687043911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044301","type":"CDM"},{"code":"60687044301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045001","type":"CDM"},{"code":"60687045001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045011","type":"CDM"},{"code":"60687045011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045401","type":"CDM"},{"code":"60687045401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045411","type":"CDM"},{"code":"60687045411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047301","type":"CDM"},{"code":"60687047301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047511","type":"CDM"},{"code":"60687047511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047601","type":"CDM"},{"code":"60687047601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047611","type":"CDM"},{"code":"60687047611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047901","type":"CDM"},{"code":"60687047901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049401","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"60687049401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050011","type":"CDM"},{"code":"60687050011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054411","type":"CDM"},{"code":"60687054411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054911","type":"CDM"},{"code":"60687054911","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055001","type":"CDM"},{"code":"60687055001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055301","type":"CDM"},{"code":"60687055301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055511","type":"CDM"},{"code":"60687055511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE CAP DR 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055632","type":"CDM"},{"code":"60687055632","type":"NDC"}],"standard_charges":[{"gross_charge":8.34,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055801","type":"CDM"},{"code":"60687055801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055901","type":"CDM"},{"code":"60687055901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REPAGLINIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056021","type":"CDM"},{"code":"60687056021","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056801","type":"CDM"},{"code":"60687056801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056811","type":"CDM"},{"code":"60687056811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057521","type":"CDM"},{"code":"60687057521","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057911","type":"CDM"},{"code":"60687057911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058001","type":"CDM"},{"code":"60687058001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058121","type":"CDM"},{"code":"60687058121","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058211","type":"CDM"},{"code":"60687058211","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058601","type":"CDM"},{"code":"60687058601","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058701","type":"CDM"},{"code":"60687058701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058711","type":"CDM"},{"code":"60687058711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059001","type":"CDM"},{"code":"60687059001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059101","type":"CDM"},{"code":"60687059101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059301","type":"CDM"},{"code":"60687059301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059801","type":"CDM"},{"code":"60687059801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059811","type":"CDM"},{"code":"60687059811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060201","type":"CDM"},{"code":"60687060201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060901","type":"CDM"},{"code":"60687060901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687061221","type":"CDM"},{"code":"60687061221","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062001","type":"CDM"},{"code":"60687062001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062011","type":"CDM"},{"code":"60687062011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062701","type":"CDM"},{"code":"60687062701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063101","type":"CDM"},{"code":"60687063101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063111","type":"CDM"},{"code":"60687063111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065611","type":"CDM"},{"code":"60687065611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065621","type":"CDM"},{"code":"60687065621","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066101","type":"CDM"},{"code":"60687066101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066401","type":"CDM"},{"code":"60687066401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066901","type":"CDM"},{"code":"60687066901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067211","type":"CDM"},{"code":"60687067211","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067265","type":"CDM"},{"code":"60687067265","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATEGLINIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067311","type":"CDM"},{"code":"60687067311","type":"NDC"}],"standard_charges":[{"gross_charge":30.09,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATEGLINIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067321","type":"CDM"},{"code":"60687067321","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067701","type":"CDM"},{"code":"60687067701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067711","type":"CDM"},{"code":"60687067711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067911","type":"CDM"},{"code":"60687067911","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068301","type":"CDM"},{"code":"60687068301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069301","type":"CDM"},{"code":"60687069301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069501","type":"CDM"},{"code":"60687069501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069511","type":"CDM"},{"code":"60687069511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070911","type":"CDM"},{"code":"60687070911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071701","type":"CDM"},{"code":"60687071701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071711","type":"CDM"},{"code":"60687071711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072801","type":"CDM"},{"code":"60687072801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074201","type":"CDM"},{"code":"60687074201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074601","type":"CDM"},{"code":"60687074601","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079501","type":"CDM"},{"code":"60687079501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079511","type":"CDM"},{"code":"60687079511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687080701","type":"CDM"},{"code":"60687080701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687081511","type":"CDM"},{"code":"60687081511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083301","type":"CDM"},{"code":"60687083301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083311","type":"CDM"},{"code":"60687083311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083601","type":"CDM"},{"code":"60687083601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086011","type":"CDM"},{"code":"60687086011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOBUNOLOL HCL OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758006005","type":"CDM"},{"code":"60758006005","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758011905","type":"CDM"},{"code":"60758011905","type":"NDC"}],"standard_charges":[{"gross_charge":61.38,"discounted_cash":21.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60758080110","type":"CDM"},{"code":"60758080110","type":"NDC"}],"standard_charges":[{"gross_charge":11.17,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOROMETHOLONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758088005","type":"CDM"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"gross_charge":106.44,"discounted_cash":37.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60793011501","type":"CDM"},{"code":"60793011501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G PROCAINE INTRAMUSCULAR SUSP 600000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793013001","type":"CDM"},{"code":"J2510","type":"HCPCS"},{"code":"60793013001","type":"NDC"}],"standard_charges":[{"gross_charge":358.14,"discounted_cash":125.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60793060002","type":"CDM"},{"code":"J0558","type":"HCPCS"},{"code":"60793060002","type":"NDC"}],"standard_charges":[{"gross_charge":1424.41,"discounted_cash":498.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G BENZATHINE & PROCAINE INJ 900000-300000 UNT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60793060210","type":"CDM"},{"code":"J05858","type":"HCPCS"},{"code":"60793060210","type":"NDC"}],"standard_charges":[{"gross_charge":2495.58,"discounted_cash":873.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 600000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070001","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070001","type":"NDC"}],"standard_charges":[{"gross_charge":2187.16,"discounted_cash":765.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070102","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070102","type":"NDC"}],"standard_charges":[{"gross_charge":1894.12,"discounted_cash":662.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070110","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":1894.73,"discounted_cash":663.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 2400000 UNIT/4ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070204","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070204","type":"NDC"}],"standard_charges":[{"gross_charge":915.51,"discounted_cash":320.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60951065870","type":"CDM"},{"code":"60951065870","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRALIDOXIME CHLORIDE FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60977014127","type":"CDM"},{"code":"J2730","type":"HCPCS"},{"code":"60977014127","type":"NDC"}],"standard_charges":[{"gross_charge":900.05,"discounted_cash":315.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314001601","type":"CDM"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314003002","type":"CDM"},{"code":"61314003002","type":"NDC"}],"standard_charges":[{"gross_charge":27.9,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIFLURIDINE OPHTH SOLN 1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx61314004475","type":"CDM"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"gross_charge":269.47,"discounted_cash":94.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314014310","type":"CDM"},{"code":"61314014310","type":"NDC"}],"standard_charges":[{"gross_charge":15.78,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020315","type":"CDM"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":58.65,"discounted_cash":20.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020415","type":"CDM"},{"code":"61314020415","type":"NDC"}],"standard_charges":[{"gross_charge":57.53,"discounted_cash":20.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020615","type":"CDM"},{"code":"61314020615","type":"NDC"}],"standard_charges":[{"gross_charge":64.62,"discounted_cash":22.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314022610","type":"CDM"},{"code":"61314022610","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314022705","type":"CDM"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DENOSUMAB-BBDZ INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx61314024063","type":"CDM"},{"code":"Q5136","type":"HCPCS"},{"code":"61314024063","type":"NDC"}],"standard_charges":[{"gross_charge":15484.89,"discounted_cash":5419.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314024503","type":"CDM"},{"code":"61314024503","type":"NDC"}],"standard_charges":[{"gross_charge":131.86,"discounted_cash":46.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx61314031801","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"gross_charge":1464.62,"discounted_cash":512.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx61314034201","type":"CDM"},{"code":"61314034201","type":"NDC"}],"standard_charges":[{"gross_charge":23.16,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx61314035501","type":"CDM"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":4.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314054701","type":"CDM"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":8.68,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063006","type":"CDM"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063705","type":"CDM"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":44.62,"discounted_cash":15.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OPHTH SUSP","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx61314064175","type":"CDM"},{"code":"61314064175","type":"NDC"}],"standard_charges":[{"gross_charge":189.5,"discounted_cash":66.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314064725","type":"CDM"},{"code":"61314064725","type":"NDC"}],"standard_charges":[{"gross_charge":52.9,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442010201","type":"CDM"},{"code":"61442010201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442010260","type":"CDM"},{"code":"61442010260","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442010301","type":"CDM"},{"code":"61442010301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442010360","type":"CDM"},{"code":"61442010360","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE 0.125% IN NS DOUBLE LUMEN ON-Q PUMP 550 ML","drug_information":{"unit":550.0,"type":"ML"},"code_information":[{"code":"Rx61553042313","type":"CDM"},{"code":"61553042313","type":"NDC"}],"standard_charges":[{"gross_charge":572.88,"discounted_cash":200.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 150 MG/150ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx61553051069","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"61553051069","type":"NDC"}],"standard_charges":[{"gross_charge":319.11,"discounted_cash":111.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx61553052569","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"61553052569","type":"NDC"}],"standard_charges":[{"gross_charge":378.75,"discounted_cash":132.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN B GU IRRIGATION SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx61570004701","type":"CDM"},{"code":"61570004701","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":20.0,"type":"GM"},"code_information":[{"code":"Rx61570013120","type":"CDM"},{"code":"61570013120","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx61570013125","type":"CDM"},{"code":"61570013125","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUINUPRISTIN-DALFOPRISTIN FOR INJ 500 MG (150-350 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61570026001","type":"CDM"},{"code":"J2770","type":"HCPCS"},{"code":"61570026001","type":"NDC"}],"standard_charges":[{"gross_charge":4821.85,"discounted_cash":1687.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUINUPRISTIN-DALFOPRISTIN FOR INJ 500 MG (150-350 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61570026010","type":"CDM"},{"code":"J2770","type":"HCPCS"},{"code":"61570026010","type":"NDC"}],"standard_charges":[{"gross_charge":4821.85,"discounted_cash":1687.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYTARABINE INJ PF 20 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx61703030346","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"61703030346","type":"NDC"}],"standard_charges":[{"gross_charge":301.23,"discounted_cash":105.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYTARABINE INJ 20 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx61703030436","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"61703030436","type":"NDC"}],"standard_charges":[{"gross_charge":289.55,"discounted_cash":101.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYTARABINE INJ PF 20 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703030538","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":264.59,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx61703030906","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":285.18,"discounted_cash":99.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61703030916","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"61703030916","type":"NDC"}],"standard_charges":[{"gross_charge":289.62,"discounted_cash":101.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYTARABINE INJ PF 100 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx61703031922","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"61703031922","type":"NDC"}],"standard_charges":[{"gross_charge":297.16,"discounted_cash":104.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 3 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61703032418","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"61703032418","type":"NDC"}],"standard_charges":[{"gross_charge":147.72,"discounted_cash":51.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 6 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61703032518","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"61703032518","type":"NDC"}],"standard_charges":[{"gross_charge":413.05,"discounted_cash":144.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 9 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61703032618","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"61703032618","type":"NDC"}],"standard_charges":[{"gross_charge":384.27,"discounted_cash":134.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61703032722","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"61703032722","type":"NDC"}],"standard_charges":[{"gross_charge":413.66,"discounted_cash":144.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BLEOMYCIN SULFATE FOR INJ 15 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61703033218","type":"CDM"},{"code":"J9040","type":"HCPCS"},{"code":"61703033218","type":"NDC"}],"standard_charges":[{"gross_charge":630.17,"discounted_cash":220.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703033918","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033918","type":"NDC"}],"standard_charges":[{"gross_charge":288.16,"discounted_cash":100.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 150 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61703033922","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033922","type":"NDC"}],"standard_charges":[{"gross_charge":289.15,"discounted_cash":101.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx61703033950","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033950","type":"NDC"}],"standard_charges":[{"gross_charge":307.84,"discounted_cash":107.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML)","drug_information":{"unit":16.7,"type":"ML"},"code_information":[{"code":"Rx61703034222","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"61703034222","type":"NDC"}],"standard_charges":[{"gross_charge":397.48,"discounted_cash":139.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx61703034250","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":735.15,"discounted_cash":257.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MITOXANTRONE HCL INJ CONC 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61703034318","type":"CDM"},{"code":"J9293","type":"HCPCS"},{"code":"61703034318","type":"NDC"}],"standard_charges":[{"gross_charge":1731.28,"discounted_cash":605.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 50 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61703036018","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703036018","type":"NDC"}],"standard_charges":[{"gross_charge":288.16,"discounted_cash":100.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61703036318","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"61703036318","type":"NDC"}],"standard_charges":[{"gross_charge":578.08,"discounted_cash":202.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRAZINAMIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001201","type":"CDM"},{"code":"61748001201","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRAZINAMIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001211","type":"CDM"},{"code":"61748001211","type":"NDC"}],"standard_charges":[{"gross_charge":7.15,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001401","type":"CDM"},{"code":"61748001401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001511","type":"CDM"},{"code":"61748001511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001811","type":"CDM"},{"code":"61748001811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61748001860","type":"CDM"},{"code":"61748001860","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL ORAL SOLN 0.4 MG/ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61748005416","type":"CDM"},{"code":"61748005416","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CASIRIVIMAB-IMDEVIMAB INJ SOLN 600-600 MG/10ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61755003900","type":"CDM"},{"code":"61755003900","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CASIRIVIMAB-IMDEVIMAB INJ SOLN 600-600 MG/10ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61755003901","type":"CDM"},{"code":"61755003901","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958040101","type":"CDM"},{"code":"61958040101","type":"NDC"}],"standard_charges":[{"gross_charge":57.46,"discounted_cash":20.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EMTRICITABINE CAPS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958060101","type":"CDM"},{"code":"61958060101","type":"NDC"}],"standard_charges":[{"gross_charge":24.59,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958100301","type":"CDM"},{"code":"61958100301","type":"NDC"}],"standard_charges":[{"gross_charge":9.49,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICTEGRAVIR-EMTRICITABINE-TENOFOVIR AF TAB 50-200-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958250103","type":"CDM"},{"code":"61958250103","type":"NDC"}],"standard_charges":[{"gross_charge":193.28,"discounted_cash":67.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REMDESIVIR FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958290102","type":"CDM"},{"code":"J0248","type":"HCPCS"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"gross_charge":7251.66,"discounted_cash":2538.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REMDESIVIR IV SOLN 100 MG/20ML (5 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx61958290201","type":"CDM"},{"code":"J0248","type":"HCPCS"},{"code":"61958290201","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62135019122","type":"CDM"},{"code":"62135019122","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62135071242","type":"CDM"},{"code":"62135071242","type":"NDC"}],"standard_charges":[{"gross_charge":6.73,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62135096001","type":"CDM"},{"code":"62135096001","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327033343","type":"CDM"},{"code":"62327033343","type":"NDC"}],"standard_charges":[{"gross_charge":1400.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327044444","type":"CDM"},{"code":"62327044444","type":"NDC"}],"standard_charges":[{"gross_charge":1568.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332002890","type":"CDM"},{"code":"62332002890","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332004490","type":"CDM"},{"code":"62332004490","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332011431","type":"CDM"},{"code":"62332011431","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332017160","type":"CDM"},{"code":"62332017160","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332038530","type":"CDM"},{"code":"62332038530","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332038590","type":"CDM"},{"code":"62332038590","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332038630","type":"CDM"},{"code":"62332038630","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332041310","type":"CDM"},{"code":"62332041310","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE OINT 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx62332058515","type":"CDM"},{"code":"62332058515","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE ENEMA 100 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx62559013807","type":"CDM"},{"code":"62559013807","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE ENEMA 100 MG/60ML","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx62559013811","type":"CDM"},{"code":"62559013811","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUVOXAMINE MALEATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559015901","type":"CDM"},{"code":"62559015901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUVOXAMINE MALEATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559016001","type":"CDM"},{"code":"62559016001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62559019016","type":"CDM"},{"code":"62559019016","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559021031","type":"CDM"},{"code":"62559021031","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559021081","type":"CDM"},{"code":"62559021081","type":"NDC"}],"standard_charges":[{"gross_charge":18.06,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MESALAMINE ENEMA 4 GM","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx62559042011","type":"CDM"},{"code":"62559042011","type":"NDC"}],"standard_charges":[{"gross_charge":18.45,"discounted_cash":6.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559042101","type":"CDM"},{"code":"62559042101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559042401","type":"CDM"},{"code":"62559042401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDAPAMIDE TAB 1.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559051001","type":"CDM"},{"code":"62559051001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559053101","type":"CDM"},{"code":"62559053101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62559063001","type":"CDM"},{"code":"62559063001","type":"NDC"}],"standard_charges":[{"gross_charge":14.47,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559072101","type":"CDM"},{"code":"62559072101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THYROID TAB 15 MG (1/4 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559074001","type":"CDM"},{"code":"62559074001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"THYROID TAB 30 MG (1/2 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559074101","type":"CDM"},{"code":"62559074101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026511","type":"CDM"},{"code":"62584026511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026601","type":"CDM"},{"code":"62584026601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026611","type":"CDM"},{"code":"62584026611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026701","type":"CDM"},{"code":"62584026701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026711","type":"CDM"},{"code":"62584026711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584033201","type":"CDM"},{"code":"62584033201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584033211","type":"CDM"},{"code":"62584033211","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584069311","type":"CDM"},{"code":"62584069311","type":"NDC"}],"standard_charges":[{"gross_charge":5.32,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584069321","type":"CDM"},{"code":"62584069321","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584071311","type":"CDM"},{"code":"62584071311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584074811","type":"CDM"},{"code":"62584074811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584097401","type":"CDM"},{"code":"62584097401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584097411","type":"CDM"},{"code":"62584097411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPOPROSTENOL SODIUM FOR INJ 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756005940","type":"CDM"},{"code":"J1325","type":"HCPCS"},{"code":"62756005940","type":"NDC"}],"standard_charges":[{"gross_charge":113.79,"discounted_cash":39.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHOTERICIN B LIPOSOME IV FOR SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756023301","type":"CDM"},{"code":"J0289","type":"HCPCS"},{"code":"62756023301","type":"NDC"}],"standard_charges":[{"gross_charge":2083.98,"discounted_cash":729.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE OTIC SUSP 0.3-0.1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx62756042790","type":"CDM"},{"code":"62756042790","type":"NDC"}],"standard_charges":[{"gross_charge":312.73,"discounted_cash":109.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756046188","type":"CDM"},{"code":"62756046188","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051788","type":"CDM"},{"code":"62756051788","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051813","type":"CDM"},{"code":"62756051813","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756058988","type":"CDM"},{"code":"62756058988","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756059088","type":"CDM"},{"code":"62756059088","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756079788","type":"CDM"},{"code":"62756079788","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PERAMPANEL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62856027430","type":"CDM"},{"code":"62856027430","type":"NDC"}],"standard_charges":[{"gross_charge":53.11,"discounted_cash":18.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62856070510","type":"CDM"},{"code":"62856070510","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFURIC ACID-SULFONATED PHENOLICS SOLN 30-50%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62942010102","type":"CDM"},{"code":"62942010102","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL 125 MG/125ML IN DEXTROSE 5% IV SOLN (1 MG/ML)","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx63037011905","type":"CDM"},{"code":"63037011905","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63037017325","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"63037017325","type":"NDC"}],"standard_charges":[{"gross_charge":93.85,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FE FUMARATE W/ B12-VIT C-FA-IFC CAP 110-0.015-75-0.5-240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63044063510","type":"CDM"},{"code":"63044063510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TALC INTRAPLEURAL AEROSOL POWDER 4 GM (0.4 GM/SECOND)","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx63256010030","type":"CDM"},{"code":"63256010030","type":"NDC"}],"standard_charges":[{"gross_charge":151.2,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER FOR SUSP 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63256020005","type":"CDM"},{"code":"63256020005","type":"NDC"}],"standard_charges":[{"gross_charge":1181.6,"discounted_cash":413.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304069650","type":"CDM"},{"code":"63304069650","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323001002","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323001020","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":256.03,"discounted_cash":89.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORAMPHENICOL SODIUM SUCCINATE FOR IV INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323001115","type":"CDM"},{"code":"J0720","type":"HCPCS"},{"code":"63323001115","type":"NDC"}],"standard_charges":[{"gross_charge":405.52,"discounted_cash":141.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001210","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001210","type":"NDC"}],"standard_charges":[{"gross_charge":94.18,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001211","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001211","type":"NDC"}],"standard_charges":[{"gross_charge":94.13,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001212","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001212","type":"NDC"}],"standard_charges":[{"gross_charge":93.95,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MANNITOL IV SOLN 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323002425","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"63323002425","type":"NDC"}],"standard_charges":[{"gross_charge":98.65,"discounted_cash":34.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"},{"gross_charge":245.9,"discounted_cash":86.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323002605","type":"CDM"},{"code":"63323002605","type":"NDC"}],"standard_charges":[{"gross_charge":95.62,"discounted_cash":33.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006404","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006404","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006410","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006410","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006411","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323008305","type":"CDM"},{"code":"63323008305","type":"NDC"}],"standard_charges":[{"gross_charge":241.52,"discounted_cash":84.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323009330","type":"CDM"},{"code":"63323009330","type":"NDC"}],"standard_charges":[{"gross_charge":99.1,"discounted_cash":34.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323009561","type":"CDM"},{"code":"63323009561","type":"NDC"}],"standard_charges":[{"gross_charge":96.97,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323009963","type":"CDM"},{"code":"63323009963","type":"NDC"}],"standard_charges":[{"gross_charge":96.97,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISPLATIN INJ 200 MG/200ML (1 MG/ML)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx63323010364","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010364","type":"NDC"}],"standard_charges":[{"gross_charge":749.49,"discounted_cash":262.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010365","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"gross_charge":462.82,"discounted_cash":161.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323010405","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"63323010405","type":"NDC"}],"standard_charges":[{"gross_charge":236.76,"discounted_cash":82.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx63323010425","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"gross_charge":318.46,"discounted_cash":111.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010601","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010601","type":"NDC"}],"standard_charges":[{"gross_charge":242.6,"discounted_cash":84.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010603","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010603","type":"NDC"}],"standard_charges":[{"gross_charge":243.65,"discounted_cash":85.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010605","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":243.65,"discounted_cash":85.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 40 GM/1000ML (40 MG/ML)","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323010610","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010610","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323010615","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010615","type":"NDC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010800","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010800","type":"NDC"}],"standard_charges":[{"gross_charge":243.7,"discounted_cash":85.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010801","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010801","type":"NDC"}],"standard_charges":[{"gross_charge":242.8,"discounted_cash":84.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323011310","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"63323011310","type":"NDC"}],"standard_charges":[{"gross_charge":502.92,"discounted_cash":176.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011710","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":261.76,"discounted_cash":91.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 1 GM/20ML (50 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323011720","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"gross_charge":264.4,"discounted_cash":92.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BLEOMYCIN SULFATE FOR INJ 15 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013610","type":"CDM"},{"code":"J9040","type":"HCPCS"},{"code":"63323013610","type":"NDC"}],"standard_charges":[{"gross_charge":405.98,"discounted_cash":142.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016202","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"gross_charge":93.38,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323016501","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"gross_charge":94.56,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 120 MG/30ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323016530","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323016530","type":"NDC"}],"standard_charges":[{"gross_charge":93.76,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323017005","type":"CDM"},{"code":"63323017005","type":"NDC"}],"standard_charges":[{"gross_charge":166.99,"discounted_cash":58.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx63323017245","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"63323017245","type":"NDC"}],"standard_charges":[{"gross_charge":1009.71,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323017302","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":95.14,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOXINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323018001","type":"CDM"},{"code":"J3415","type":"HCPCS"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":124.32,"discounted_cash":43.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323018410","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":93.67,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018601","type":"CDM"},{"code":"63323018601","type":"NDC"}],"standard_charges":[{"gross_charge":93.28,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323018730","type":"CDM"},{"code":"63323018730","type":"NDC"}],"standard_charges":[{"gross_charge":97.39,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020805","type":"CDM"},{"code":"63323020805","type":"NDC"}],"standard_charges":[{"gross_charge":93.53,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022905","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":95.24,"discounted_cash":33.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022930","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":94.45,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323026922","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026922","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323026922","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026922","type":"NDC"}],"standard_charges":[{"gross_charge":95.31,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323026929","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":93.43,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323026929","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":95.09,"discounted_cash":33.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323026935","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026935","type":"NDC"}],"standard_charges":[{"gross_charge":102.45,"discounted_cash":35.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323026950","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":97.85,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323026965","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":102.45,"discounted_cash":35.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323026967","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026967","type":"NDC"}],"standard_charges":[{"gross_charge":102.45,"discounted_cash":35.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VINBLASTINE SULFATE INJ 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323027810","type":"CDM"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":659.1,"discounted_cash":230.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323028003","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"63323028003","type":"NDC"}],"standard_charges":[{"gross_charge":93.68,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323028004","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"63323028004","type":"NDC"}],"standard_charges":[{"gross_charge":93.68,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323028420","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"gross_charge":97.35,"discounted_cash":34.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028623","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028623","type":"NDC"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":32.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028630","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028630","type":"NDC"}],"standard_charges":[{"gross_charge":96.21,"discounted_cash":33.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028635","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028635","type":"NDC"}],"standard_charges":[{"gross_charge":94.01,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028811","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028811","type":"NDC"}],"standard_charges":[{"gross_charge":95.02,"discounted_cash":33.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323029401","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029401","type":"NDC"}],"standard_charges":[{"gross_charge":94.81,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323029427","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"gross_charge":94.79,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323030602","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"gross_charge":94.52,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"},{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 1.2 GM/30ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323030630","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030630","type":"NDC"}],"standard_charges":[{"gross_charge":126.67,"discounted_cash":44.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323031110","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323031110","type":"NDC"}],"standard_charges":[{"gross_charge":96.35,"discounted_cash":33.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323031150","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323031150","type":"NDC"}],"standard_charges":[{"gross_charge":94.27,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GANCICLOVIR SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323031510","type":"CDM"},{"code":"J1570","type":"HCPCS"},{"code":"63323031510","type":"NDC"}],"standard_charges":[{"gross_charge":495.53,"discounted_cash":173.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323032110","type":"CDM"},{"code":"63323032110","type":"NDC"}],"standard_charges":[{"gross_charge":122.64,"discounted_cash":42.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323032510","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032510","type":"NDC"}],"standard_charges":[{"gross_charge":95.92,"discounted_cash":33.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323032520","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032520","type":"NDC"}],"standard_charges":[{"gross_charge":97.37,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323032820","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"63323032820","type":"NDC"}],"standard_charges":[{"gross_charge":296.47,"discounted_cash":103.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323032821","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"63323032821","type":"NDC"}],"standard_charges":[{"gross_charge":299.81,"discounted_cash":104.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036001","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036001","type":"NDC"}],"standard_charges":[{"gross_charge":97.65,"discounted_cash":34.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036019","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":96.91,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323036701","type":"CDM"},{"code":"63323036701","type":"NDC"}],"standard_charges":[{"gross_charge":114.09,"discounted_cash":39.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323036920","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"63323036920","type":"NDC"}],"standard_charges":[{"gross_charge":100.42,"discounted_cash":35.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323037601","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037601","type":"NDC"}],"standard_charges":[{"gross_charge":95.54,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323037700","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037700","type":"NDC"}],"standard_charges":[{"gross_charge":95.41,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323037701","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"gross_charge":95.4,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COLISTIMETHATE SOD FOR INJ 150 MG (COLISTIN BASE ACTIVITY)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039306","type":"CDM"},{"code":"J0770","type":"HCPCS"},{"code":"63323039306","type":"NDC"}],"standard_charges":[{"gross_charge":112.67,"discounted_cash":39.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040120","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"gross_charge":226.56,"discounted_cash":79.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040220","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"gross_charge":462.68,"discounted_cash":161.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323040302","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040302","type":"NDC"}],"standard_charges":[{"gross_charge":98.26,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323042405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323042405","type":"NDC"}],"standard_charges":[{"gross_charge":95.96,"discounted_cash":33.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323042410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323042410","type":"NDC"}],"standard_charges":[{"gross_charge":152.29,"discounted_cash":53.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx63323043400","type":"CDM"},{"code":"J0134","type":"HCPCS"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx63323043401","type":"CDM"},{"code":"J0134","type":"HCPCS"},{"code":"63323043401","type":"NDC"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323045200","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045200","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323045201","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx63323045400","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045400","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.75% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046037","type":"CDM"},{"code":"63323046037","type":"NDC"}],"standard_charges":[{"gross_charge":93.64,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046157","type":"CDM"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"gross_charge":95.03,"discounted_cash":33.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046204","type":"CDM"},{"code":"63323046204","type":"NDC"}],"standard_charges":[{"gross_charge":94.96,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046217","type":"CDM"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"gross_charge":96.84,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046231","type":"CDM"},{"code":"63323046231","type":"NDC"}],"standard_charges":[{"gross_charge":94.52,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046237","type":"CDM"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":95.24,"discounted_cash":33.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046417","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046431","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046431","type":"NDC"}],"standard_charges":[{"gross_charge":94.05,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046617","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"gross_charge":95.86,"discounted_cash":33.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046801","type":"CDM"},{"code":"63323046801","type":"NDC"}],"standard_charges":[{"gross_charge":94.92,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046837","type":"CDM"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"gross_charge":95.1,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323047401","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":93.96,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047727","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"63323047727","type":"NDC"}],"standard_charges":[{"gross_charge":97.84,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047827","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"63323047827","type":"NDC"}],"standard_charges":[{"gross_charge":98.07,"discounted_cash":34.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 0.5% W/ EPINEPHRINE-1:200000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048157","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048157","type":"NDC"}],"standard_charges":[{"gross_charge":93.38,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048205","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048205","type":"NDC"}],"standard_charges":[{"gross_charge":93.35,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048217","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048217","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048227","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":93.46,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048327","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":93.46,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048527","type":"CDM"},{"code":"63323048527","type":"NDC"}],"standard_charges":[{"gross_charge":93.33,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048707","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048707","type":"NDC"}],"standard_charges":[{"gross_charge":93.48,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048717","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048717","type":"NDC"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":32.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048737","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048737","type":"NDC"}],"standard_charges":[{"gross_charge":93.64,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323048807","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048807","type":"NDC"}],"standard_charges":[{"gross_charge":94.18,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323048831","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048831","type":"NDC"}],"standard_charges":[{"gross_charge":94.03,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 1.5% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323048837","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048837","type":"NDC"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048902","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048902","type":"NDC"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048917","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048917","type":"NDC"}],"standard_charges":[{"gross_charge":97.95,"discounted_cash":34.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048927","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":97.73,"discounted_cash":34.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049089","type":"CDM"},{"code":"63323049089","type":"NDC"}],"standard_charges":[{"gross_charge":95.93,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323049157","type":"CDM"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":95.77,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049227","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049227","type":"NDC"}],"standard_charges":[{"gross_charge":94.11,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323049405","type":"NDC"}],"standard_charges":[{"gross_charge":99.95,"discounted_cash":34.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049507","type":"CDM"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"gross_charge":93.63,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049527","type":"CDM"},{"code":"63323049527","type":"NDC"}],"standard_charges":[{"gross_charge":94.51,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323050601","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":93.47,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050720","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":95.89,"discounted_cash":33.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050830","type":"NDC"}],"standard_charges":[{"gross_charge":98.55,"discounted_cash":34.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051774","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051774","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 3%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323053075","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"63323053075","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx63323053701","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053701","type":"NDC"}],"standard_charges":[{"gross_charge":124.61,"discounted_cash":43.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323054001","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054001","type":"NDC"}],"standard_charges":[{"gross_charge":94.7,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054001","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054001","type":"NDC"}],"standard_charges":[{"gross_charge":96.15,"discounted_cash":33.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323054011","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054011","type":"NDC"}],"standard_charges":[{"gross_charge":95.48,"discounted_cash":33.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054011","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054011","type":"NDC"}],"standard_charges":[{"gross_charge":93.69,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054013","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054013","type":"NDC"}],"standard_charges":[{"gross_charge":94.84,"discounted_cash":33.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054031","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054031","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323054031","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054031","type":"NDC"}],"standard_charges":[{"gross_charge":98.17,"discounted_cash":34.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055993","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055993","type":"NDC"}],"standard_charges":[{"gross_charge":95.49,"discounted_cash":33.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056421","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056421","type":"NDC"}],"standard_charges":[{"gross_charge":100.63,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056497","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056497","type":"NDC"}],"standard_charges":[{"gross_charge":95.96,"discounted_cash":33.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056621","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056621","type":"NDC"}],"standard_charges":[{"gross_charge":102.49,"discounted_cash":35.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056698","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056698","type":"NDC"}],"standard_charges":[{"gross_charge":96.71,"discounted_cash":33.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323056883","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056883","type":"NDC"}],"standard_charges":[{"gross_charge":95.8,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323056884","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056884","type":"NDC"}],"standard_charges":[{"gross_charge":100.9,"discounted_cash":35.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056887","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056887","type":"NDC"}],"standard_charges":[{"gross_charge":96.66,"discounted_cash":33.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056888","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056888","type":"NDC"}],"standard_charges":[{"gross_charge":97.3,"discounted_cash":34.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx63323056890","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056890","type":"NDC"}],"standard_charges":[{"gross_charge":99.19,"discounted_cash":34.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056898","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056898","type":"NDC"}],"standard_charges":[{"gross_charge":97.3,"discounted_cash":34.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx63323056990","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056990","type":"NDC"}],"standard_charges":[{"gross_charge":102.61,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLUCAGON HCL FOR INJ 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323058282","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323058282","type":"NDC"}],"standard_charges":[{"gross_charge":2207.07,"discounted_cash":772.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058621","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058621","type":"NDC"}],"standard_charges":[{"gross_charge":185.19,"discounted_cash":64.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059303","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059303","type":"NDC"}],"standard_charges":[{"gross_charge":1266.83,"discounted_cash":443.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059603","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059603","type":"NDC"}],"standard_charges":[{"gross_charge":1185.74,"discounted_cash":415.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059710","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"63323059710","type":"NDC"}],"standard_charges":[{"gross_charge":151.42,"discounted_cash":53.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059930","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"63323059930","type":"NDC"}],"standard_charges":[{"gross_charge":252.22,"discounted_cash":88.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323060401","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"63323060401","type":"NDC"}],"standard_charges":[{"gross_charge":95.17,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323060501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323060501","type":"NDC"}],"standard_charges":[{"gross_charge":100.93,"discounted_cash":35.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323060701","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323060701","type":"NDC"}],"standard_charges":[{"gross_charge":97.31,"discounted_cash":34.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323060788","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323060788","type":"NDC"}],"standard_charges":[{"gross_charge":97.3,"discounted_cash":34.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323061400","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061400","type":"NDC"}],"standard_charges":[{"gross_charge":94.03,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061401","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":96.34,"discounted_cash":33.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323061603","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":95.07,"discounted_cash":33.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064710","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"63323064710","type":"NDC"}],"standard_charges":[{"gross_charge":1674.73,"discounted_cash":586.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064810","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"63323064810","type":"NDC"}],"standard_charges":[{"gross_charge":5413.52,"discounted_cash":1894.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064907","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323064907","type":"NDC"}],"standard_charges":[{"gross_charge":863.07,"discounted_cash":302.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323065010","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"63323065010","type":"NDC"}],"standard_charges":[{"gross_charge":21700.72,"discounted_cash":7595.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 12 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323065104","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"63323065104","type":"NDC"}],"standard_charges":[{"gross_charge":112.15,"discounted_cash":39.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx63323065599","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323065599","type":"NDC"}],"standard_charges":[{"gross_charge":100.83,"discounted_cash":35.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323065820","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"63323065820","type":"NDC"}],"standard_charges":[{"gross_charge":436.35,"discounted_cash":152.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN SODIUM IV FOR SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323065903","type":"CDM"},{"code":"63323065903","type":"NDC"}],"standard_charges":[{"gross_charge":2979.31,"discounted_cash":1042.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066401","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066501","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":94.69,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323068310","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323068310","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323069030","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx63323069404","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072303","type":"CDM"},{"code":"63323072303","type":"NDC"}],"standard_charges":[{"gross_charge":802.36,"discounted_cash":280.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072910","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"63323072910","type":"NDC"}],"standard_charges":[{"gross_charge":314.03,"discounted_cash":109.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323073912","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323075100","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"63323075100","type":"NDC"}],"standard_charges":[{"gross_charge":94.64,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323076350","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"63323076350","type":"NDC"}],"standard_charges":[{"gross_charge":1323.2,"discounted_cash":463.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 25 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323080601","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63323080601","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323081220","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"63323081220","type":"NDC"}],"standard_charges":[{"gross_charge":97.44,"discounted_cash":34.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXACILLIN SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323081320","type":"CDM"},{"code":"J2700","type":"HCPCS"},{"code":"63323081320","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAT EMULSION FISH OIL AND PLANT BASED IV EMUL 20%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323082000","type":"CDM"},{"code":"63323082000","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323082320","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"63323082320","type":"NDC"}],"standard_charges":[{"gross_charge":338.99,"discounted_cash":118.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323085150","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"63323085150","type":"NDC"}],"standard_charges":[{"gross_charge":564.88,"discounted_cash":197.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx63323085303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"63323085303","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323086910","type":"CDM"},{"code":"63323086910","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323088406","type":"CDM"},{"code":"63323088406","type":"NDC"}],"standard_charges":[{"gross_charge":99.65,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323092430","type":"CDM"},{"code":"63323092430","type":"NDC"}],"standard_charges":[{"gross_charge":95.95,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323093000","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"63323093000","type":"NDC"}],"standard_charges":[{"gross_charge":96.22,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323093001","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":96.22,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323096502","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096502","type":"NDC"}],"standard_charges":[{"gross_charge":94.51,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323096503","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096503","type":"NDC"}],"standard_charges":[{"gross_charge":95.34,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323096510","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":95.34,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323096520","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":94.49,"discounted_cash":33.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323096600","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"63323096600","type":"NDC"}],"standard_charges":[{"gross_charge":498.8,"discounted_cash":174.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LURASIDONE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63402030230","type":"CDM"},{"code":"63402030230","type":"NDC"}],"standard_charges":[{"gross_charge":63.06,"discounted_cash":22.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 100 MG/10ML (10 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63459010310","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":5852.21,"discounted_cash":2048.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENDAMUSTINE HCL IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx63459034804","type":"CDM"},{"code":"J9034","type":"HCPCS"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":20655.06,"discounted_cash":7229.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARSENIC TRIOXIDE IV SOLN 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63459060010","type":"CDM"},{"code":"J9017","type":"HCPCS"},{"code":"63459060010","type":"NDC"}],"standard_charges":[{"gross_charge":6615.13,"discounted_cash":2315.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63653117103","type":"CDM"},{"code":"63653117103","type":"NDC"}],"standard_charges":[{"gross_charge":9.02,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739001510","type":"CDM"},{"code":"63739001510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739004710","type":"CDM"},{"code":"63739004710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739004810","type":"CDM"},{"code":"63739004810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739005910","type":"CDM"},{"code":"63739005910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739007310","type":"CDM"},{"code":"63739007310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739007910","type":"CDM"},{"code":"63739007910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739012810","type":"CDM"},{"code":"63739012810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739016510","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"63739016510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739016610","type":"CDM"},{"code":"63739016610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL TAB 16.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739019210","type":"CDM"},{"code":"63739019210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL TAB 16.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739020010","type":"CDM"},{"code":"63739020010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739025110","type":"CDM"},{"code":"63739025110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739028310","type":"CDM"},{"code":"63739028310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739028510","type":"CDM"},{"code":"63739028510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739032810","type":"CDM"},{"code":"63739032810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739035010","type":"CDM"},{"code":"63739035010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739036710","type":"CDM"},{"code":"63739036710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739044410","type":"CDM"},{"code":"63739044410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739044610","type":"CDM"},{"code":"63739044610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739047910","type":"CDM"},{"code":"63739047910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739048010","type":"CDM"},{"code":"63739048010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739048210","type":"CDM"},{"code":"63739048210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739048610","type":"CDM"},{"code":"63739048610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739049910","type":"CDM"},{"code":"63739049910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739051410","type":"CDM"},{"code":"63739051410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739051810","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"63739051810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739051910","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"63739051910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739054410","type":"CDM"},{"code":"63739054410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739054510","type":"CDM"},{"code":"63739054510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739057710","type":"CDM"},{"code":"63739057710","type":"NDC"}],"standard_charges":[{"gross_charge":4.67,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63739063456","type":"CDM"},{"code":"63739063456","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067010","type":"CDM"},{"code":"63739067010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067201","type":"CDM"},{"code":"63739067201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739069101","type":"CDM"},{"code":"63739069101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739090210","type":"CDM"},{"code":"63739090210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63739093114","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63739093114","type":"NDC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN FOR INJ KIT 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833038602","type":"CDM"},{"code":"J7168","type":"HCPCS"},{"code":"63833038602","type":"NDC"}],"standard_charges":[{"gross_charge":11307.4,"discounted_cash":3957.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN FOR INJ KIT 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833038702","type":"CDM"},{"code":"J7168","type":"HCPCS"},{"code":"63833038702","type":"NDC"}],"standard_charges":[{"gross_charge":23277.07,"discounted_cash":8146.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 250-600 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061502","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061502","type":"NDC"}],"standard_charges":[{"gross_charge":5696.09,"discounted_cash":1993.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500-1200 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061602","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061602","type":"NDC"}],"standard_charges":[{"gross_charge":11378.97,"discounted_cash":3982.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1000-2400 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061702","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061702","type":"NDC"}],"standard_charges":[{"gross_charge":21030.8,"discounted_cash":7360.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"C1 ESTERASE INHIBITOR (HUMAN) FOR IV INJ KIT 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833082502","type":"CDM"},{"code":"J0597","type":"HCPCS"},{"code":"63833082502","type":"NDC"}],"standard_charges":[{"gross_charge":40902.62,"discounted_cash":14315.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63874037502","type":"CDM"},{"code":"63874037502","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYPROGESTERONE CAPROATE IM IN OIL 250 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx64011024301","type":"CDM"},{"code":"J1726","type":"HCPCS"},{"code":"64011024301","type":"NDC"}],"standard_charges":[{"gross_charge":8993.6,"discounted_cash":3147.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYPROGESTERONE CAPROATE SOLN AUTO-INJECTOR 275 MG/1.1ML","drug_information":{"unit":1.1,"type":"ML"},"code_information":[{"code":"Rx64011030103","type":"CDM"},{"code":"J1726","type":"HCPCS"},{"code":"64011030103","type":"NDC"}],"standard_charges":[{"gross_charge":8993.6,"discounted_cash":3147.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTIINHIBITOR COAGULANT COMPLEX FOR IV SOLN 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64193042402","type":"CDM"},{"code":"J7198","type":"HCPCS"},{"code":"64193042402","type":"NDC"}],"standard_charges":[{"gross_charge":19056.12,"discounted_cash":6669.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ANTIINHIBITOR COAGULANT COMPLEX FOR IV SOLN 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64193042602","type":"CDM"},{"code":"J7198","type":"HCPCS"},{"code":"64193042602","type":"NDC"}],"standard_charges":[{"gross_charge":9784.32,"discounted_cash":3424.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx64253033333","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"64253033333","type":"NDC"}],"standard_charges":[{"gross_charge":93.5,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx64253040030","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"64253040030","type":"NDC"}],"standard_charges":[{"gross_charge":96.46,"discounted_cash":33.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 1 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253044425","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"64253044425","type":"NDC"}],"standard_charges":[{"gross_charge":94.85,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253090091","type":"CDM"},{"code":"64253090091","type":"NDC"}],"standard_charges":[{"gross_charge":100.35,"discounted_cash":35.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380015901","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"64380015901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64380016002","type":"CDM"},{"code":"64380016002","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380017001","type":"CDM"},{"code":"64380017001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380073406","type":"CDM"},{"code":"64380073406","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380073706","type":"CDM"},{"code":"64380073706","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACARBOSE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380075906","type":"CDM"},{"code":"64380075906","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380078206","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"64380078206","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380078306","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"64380078306","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380088000","type":"CDM"},{"code":"64380088000","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380088080","type":"CDM"},{"code":"64380088080","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380088304","type":"CDM"},{"code":"64380088304","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380091806","type":"CDM"},{"code":"64380091806","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380094906","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"64380094906","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380097106","type":"CDM"},{"code":"64380097106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679005602","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"64679005602","type":"NDC"}],"standard_charges":[{"gross_charge":96.26,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679042101","type":"CDM"},{"code":"64679042101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679070101","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"64679070101","type":"NDC"}],"standard_charges":[{"gross_charge":176.62,"discounted_cash":61.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx64679072801","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"64679072801","type":"NDC"}],"standard_charges":[{"gross_charge":97.87,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679096101","type":"CDM"},{"code":"64679096101","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679098302","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"64679098302","type":"NDC"}],"standard_charges":[{"gross_charge":99.78,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64720012810","type":"CDM"},{"code":"64720012810","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64720013010","type":"CDM"},{"code":"64720013010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZALEPLON CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64720032310","type":"CDM"},{"code":"64720032310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LUBIPROSTONE CAP 8 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764008060","type":"CDM"},{"code":"64764008060","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LUBIPROSTONE CAP 24 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764024060","type":"CDM"},{"code":"64764024060","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VEDOLIZUMAB FOR IV SOLUTION 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764030020","type":"CDM"},{"code":"J3380","type":"HCPCS"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":104306.83,"discounted_cash":36507.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764030114","type":"CDM"},{"code":"64764030114","type":"NDC"}],"standard_charges":[{"gross_charge":27.21,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764091830","type":"CDM"},{"code":"64764091830","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64950034245","type":"CDM"},{"code":"64950034245","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980013301","type":"CDM"},{"code":"64980013301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980013310","type":"CDM"},{"code":"64980013310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980016101","type":"CDM"},{"code":"64980016101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCYTOSINE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980018001","type":"CDM"},{"code":"64980018001","type":"NDC"}],"standard_charges":[{"gross_charge":134.56,"discounted_cash":47.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx64980032005","type":"CDM"},{"code":"64980032005","type":"NDC"}],"standard_charges":[{"gross_charge":37.71,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLDOPA TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980057201","type":"CDM"},{"code":"64980057201","type":"NDC"}],"standard_charges":[{"gross_charge":9.07,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARGATROBAN IV SOLN 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx65145012601","type":"CDM"},{"code":"J0883","type":"HCPCS"},{"code":"65145012601","type":"NDC"}],"standard_charges":[{"gross_charge":980.2,"discounted_cash":343.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx65145013001","type":"CDM"},{"code":"65145013001","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162003311","type":"CDM"},{"code":"65162003311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162005703","type":"CDM"},{"code":"65162005703","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162005827","type":"CDM"},{"code":"65162005827","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162030609","type":"CDM"},{"code":"65162030609","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162035109","type":"CDM"},{"code":"65162035109","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162047810","type":"CDM"},{"code":"65162047810","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162054410","type":"CDM"},{"code":"65162054410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162054510","type":"CDM"},{"code":"65162054510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162059020","type":"CDM"},{"code":"65162059020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162059606","type":"CDM"},{"code":"65162059606","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162064110","type":"CDM"},{"code":"65162064110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE-DM SYRUP 6.25-15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65162068090","type":"CDM"},{"code":"65162068090","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162068110","type":"CDM"},{"code":"65162068110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162068210","type":"CDM"},{"code":"65162068210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65162069179","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"65162069179","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELBAMATE TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162073503","type":"CDM"},{"code":"65162073503","type":"NDC"}],"standard_charges":[{"gross_charge":4.69,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162074510","type":"CDM"},{"code":"65162074510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162075003","type":"CDM"},{"code":"65162075003","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162075009","type":"CDM"},{"code":"65162075009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162075710","type":"CDM"},{"code":"65162075710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162077810","type":"CDM"},{"code":"65162077810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162079108","type":"CDM"},{"code":"65162079108","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 4.6 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162082534","type":"CDM"},{"code":"65162082534","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089609","type":"CDM"},{"code":"65162089609","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089703","type":"CDM"},{"code":"65162089703","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089709","type":"CDM"},{"code":"65162089709","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx65162091838","type":"CDM"},{"code":"65162091838","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162099708","type":"CDM"},{"code":"65162099708","type":"NDC"}],"standard_charges":[{"gross_charge":12.2,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx65219016401","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"65219016401","type":"NDC"}],"standard_charges":[{"gross_charge":380.48,"discounted_cash":133.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx65219053325","type":"CDM"},{"code":"65219053325","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx65250026609","type":"CDM"},{"code":"J0666","type":"HCPCS"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"gross_charge":197.53,"discounted_cash":69.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx65250026620","type":"CDM"},{"code":"J0666","type":"HCPCS"},{"code":"65250026620","type":"NDC"}],"standard_charges":[{"gross_charge":197.53,"discounted_cash":69.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLMESARTAN MEDOXOMIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65597010310","type":"CDM"},{"code":"65597010310","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLMESARTAN MEDOXOMIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65597010410","type":"CDM"},{"code":"65597010410","type":"NDC"}],"standard_charges":[{"gross_charge":8.62,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROGESTERONE VAGINAL SUPPOSITORY 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65628006201","type":"CDM"},{"code":"65628006201","type":"NDC"}],"standard_charges":[{"gross_charge":7.39,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAXIMIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030103","type":"CDM"},{"code":"65649030103","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAXIMIN TAB 550 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030302","type":"CDM"},{"code":"65649030302","type":"NDC"}],"standard_charges":[{"gross_charge":79.36,"discounted_cash":27.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAXIMIN TAB 550 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030303","type":"CDM"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":79.36,"discounted_cash":27.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLOROTHIAZIDE SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65649031112","type":"CDM"},{"code":"65649031112","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),METHYLNALTREXONE BROMIDE SOLN PREF SYR 12 MG/0.6ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx65649055102","type":"CDM"},{"code":"J2212","type":"HCPCS"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":1163.3,"discounted_cash":407.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862000801","type":"CDM"},{"code":"65862000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862001401","type":"CDM"},{"code":"65862001401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIDOVUDINE SYRUP 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862004824","type":"CDM"},{"code":"65862004824","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMIVUDINE ORAL SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862005524","type":"CDM"},{"code":"65862005524","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ABACAVIR SULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862007360","type":"CDM"},{"code":"65862007360","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862007601","type":"CDM"},{"code":"65862007601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862011601","type":"CDM"},{"code":"65862011601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014401","type":"CDM"},{"code":"65862014401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014636","type":"CDM"},{"code":"65862014636","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014736","type":"CDM"},{"code":"65862014736","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014930","type":"CDM"},{"code":"65862014930","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014990","type":"CDM"},{"code":"65862014990","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017601","type":"CDM"},{"code":"65862017601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017760","type":"CDM"},{"code":"65862017760","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862019201","type":"CDM"},{"code":"65862019201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862019301","type":"CDM"},{"code":"65862019301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020190","type":"CDM"},{"code":"65862020190","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020290","type":"CDM"},{"code":"65862020290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020299","type":"CDM"},{"code":"65862020299","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx65862021960","type":"CDM"},{"code":"65862021960","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862022801","type":"CDM"},{"code":"65862022801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862022960","type":"CDM"},{"code":"65862022960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862029590","type":"CDM"},{"code":"65862029590","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EMTRICITABINE CAPS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862030130","type":"CDM"},{"code":"65862030130","type":"NDC"}],"standard_charges":[{"gross_charge":22.11,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862039110","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"65862039110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862049647","type":"CDM"},{"code":"65862049647","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050301","type":"CDM"},{"code":"65862050301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050320","type":"CDM"},{"code":"65862050320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052730","type":"CDM"},{"code":"65862052730","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052790","type":"CDM"},{"code":"65862052790","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052890","type":"CDM"},{"code":"65862052890","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx65862053401","type":"CDM"},{"code":"65862053401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862057030","type":"CDM"},{"code":"65862057030","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862060130","type":"CDM"},{"code":"65862060130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862064860","type":"CDM"},{"code":"65862064860","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862065401","type":"CDM"},{"code":"65862065401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067601","type":"CDM"},{"code":"65862067601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067801","type":"CDM"},{"code":"65862067801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RITONAVIR TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862068730","type":"CDM"},{"code":"65862068730","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862069201","type":"CDM"},{"code":"65862069201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862069960","type":"CDM"},{"code":"65862069960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862070020","type":"CDM"},{"code":"65862070020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHENAMINE HIPPURATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862078201","type":"CDM"},{"code":"65862078201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx65862084003","type":"CDM"},{"code":"65862084003","type":"NDC"}],"standard_charges":[{"gross_charge":46.03,"discounted_cash":16.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862092127","type":"CDM"},{"code":"65862092127","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862093090","type":"CDM"},{"code":"65862093090","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 2.4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862093190","type":"CDM"},{"code":"65862093190","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66105053803","type":"CDM"},{"code":"66105053803","type":"NDC"}],"standard_charges":[{"gross_charge":9.05,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66213042216","type":"CDM"},{"code":"66213042216","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66213042316","type":"CDM"},{"code":"66213042316","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL TAB 16.2-0.1037-0.0194-0.0065 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66213042510","type":"CDM"},{"code":"66213042510","type":"NDC"}],"standard_charges":[{"gross_charge":12.14,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100100","type":"CDM"},{"code":"66685100100","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100101","type":"CDM"},{"code":"66685100101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100200","type":"CDM"},{"code":"66685100200","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100202","type":"CDM"},{"code":"66685100202","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 200-28.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66685101100","type":"CDM"},{"code":"66685101100","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66685101200","type":"CDM"},{"code":"66685101200","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66685101202","type":"CDM"},{"code":"66685101202","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002001","type":"CDM"},{"code":"66689002001","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002050","type":"CDM"},{"code":"66689002050","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002301","type":"CDM"},{"code":"66689002301","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx66689003650","type":"CDM"},{"code":"66689003650","type":"NDC"}],"standard_charges":[{"gross_charge":8.46,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003701","type":"CDM"},{"code":"66689003701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx66689030708","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"66689030708","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIGOXIN ORAL SOLN 0.05 MG/ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx66689032702","type":"CDM"},{"code":"66689032702","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689034216","type":"CDM"},{"code":"66689034216","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CETUXIMAB IV SOLN 100 MG/50ML (2 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx66733094823","type":"CDM"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":8002.75,"discounted_cash":2800.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CETUXIMAB IV SOLN 200 MG/100ML (2 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx66733095823","type":"CDM"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":15902.85,"discounted_cash":5566.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE TAB ER 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758016013","type":"CDM"},{"code":"66758016013","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758017013","type":"CDM"},{"code":"66758017013","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOFLURANE INHAL SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx66794001710","type":"CDM"},{"code":"66794001710","type":"NDC"}],"standard_charges":[{"gross_charge":20.7,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx66794021943","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"gross_charge":247.7,"discounted_cash":86.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66794023042","type":"CDM"},{"code":"66794023042","type":"NDC"}],"standard_charges":[{"gross_charge":95.3,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESTRADIOL VAGINAL CREAM 0.01%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx66993000210","type":"CDM"},{"code":"66993000210","type":"NDC"}],"standard_charges":[{"gross_charge":34.8,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993005702","type":"CDM"},{"code":"66993005702","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATOVAQUONE-PROGUANIL HCL TAB 250-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993006027","type":"CDM"},{"code":"66993006027","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66993006272","type":"CDM"},{"code":"66993006272","type":"NDC"}],"standard_charges":[{"gross_charge":38.22,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993006851","type":"CDM"},{"code":"66993006851","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993006885","type":"CDM"},{"code":"66993006885","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUTICASONE PROPIONATE HFA INHAL AER 110 MCG/ACT","drug_information":{"unit":12.0,"type":"GM"},"code_information":[{"code":"Rx66993007996","type":"CDM"},{"code":"66993007996","type":"NDC"}],"standard_charges":[{"gross_charge":244.71,"discounted_cash":85.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE CAP ER 12HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993040932","type":"CDM"},{"code":"66993040932","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993041702","type":"CDM"},{"code":"66993041702","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993041730","type":"CDM"},{"code":"66993041730","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 1000 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993042485","type":"CDM"},{"code":"66993042485","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993043185","type":"CDM"},{"code":"66993043185","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN SUSP 25 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx66993047173","type":"CDM"},{"code":"66993047173","type":"NDC"}],"standard_charges":[{"gross_charge":37.06,"discounted_cash":12.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993066130","type":"CDM"},{"code":"66993066130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993066430","type":"CDM"},{"code":"66993066430","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx66993089815","type":"CDM"},{"code":"66993089815","type":"NDC"}],"standard_charges":[{"gross_charge":34.44,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SELEGILINE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67253070006","type":"CDM"},{"code":"67253070006","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457010810","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"67457010810","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ASCORBIC ACID INJ 500 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457011850","type":"CDM"},{"code":"67457011850","type":"NDC"}],"standard_charges":[{"gross_charge":94.06,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL INJ 900 MG/18ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015318","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015318","type":"NDC"}],"standard_charges":[{"gross_charge":95.3,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM TETRADECYL SULFATE INJ 3%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457016302","type":"CDM"},{"code":"67457016302","type":"NDC"}],"standard_charges":[{"gross_charge":799.97,"discounted_cash":279.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457019805","type":"CDM"},{"code":"67457019805","type":"NDC"}],"standard_charges":[{"gross_charge":1049.93,"discounted_cash":367.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHADONE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457021720","type":"CDM"},{"code":"J1230","type":"HCPCS"},{"code":"67457021720","type":"NDC"}],"standard_charges":[{"gross_charge":290.07,"discounted_cash":101.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457022000","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022000","type":"NDC"}],"standard_charges":[{"gross_charge":3235.69,"discounted_cash":1132.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457022005","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":3234.63,"discounted_cash":1132.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457022410","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"67457022410","type":"NDC"}],"standard_charges":[{"gross_charge":366.91,"discounted_cash":128.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457022700","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"67457022700","type":"NDC"}],"standard_charges":[{"gross_charge":915.3,"discounted_cash":320.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OCTREOTIDE ACETATE SUBCUTANEOUS SOLN PREF SYR 50 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457023900","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"67457023900","type":"NDC"}],"standard_charges":[{"gross_charge":96.68,"discounted_cash":33.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457025430","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"67457025430","type":"NDC"}],"standard_charges":[{"gross_charge":1661.86,"discounted_cash":581.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029202","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":94.27,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457033900","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457033900","type":"NDC"}],"standard_charges":[{"gross_charge":100.7,"discounted_cash":35.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUTILIDE FUMARATE INJ 1 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457036610","type":"CDM"},{"code":"J1742","type":"HCPCS"},{"code":"67457036610","type":"NDC"}],"standard_charges":[{"gross_charge":3062.3,"discounted_cash":1071.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042300","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042300","type":"NDC"}],"standard_charges":[{"gross_charge":93.47,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042312","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"gross_charge":93.47,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042600","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042600","type":"NDC"}],"standard_charges":[{"gross_charge":94.06,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 3 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457043010","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":101.69,"discounted_cash":35.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457043322","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":93.48,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXORUBICIN HCL FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043650","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"67457043650","type":"NDC"}],"standard_charges":[{"gross_charge":1753.84,"discounted_cash":613.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043800","type":"CDM"},{"code":"67457043800","type":"NDC"}],"standard_charges":[{"gross_charge":97.88,"discounted_cash":34.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043810","type":"CDM"},{"code":"67457043810","type":"NDC"}],"standard_charges":[{"gross_charge":98.47,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN FOR INJ 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457044560","type":"CDM"},{"code":"J2804","type":"HCPCS"},{"code":"67457044560","type":"NDC"}],"standard_charges":[{"gross_charge":1331.23,"discounted_cash":465.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 9 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457044610","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"67457044610","type":"NDC"}],"standard_charges":[{"gross_charge":288.06,"discounted_cash":100.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457047322","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322","type":"NDC"}],"standard_charges":[{"gross_charge":94.01,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457053035","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"gross_charge":304.16,"discounted_cash":106.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457058200","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058200","type":"NDC"}],"standard_charges":[{"gross_charge":102.53,"discounted_cash":35.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457058210","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058210","type":"NDC"}],"standard_charges":[{"gross_charge":102.43,"discounted_cash":35.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx67457058508","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058508","type":"NDC"}],"standard_charges":[{"gross_charge":328.73,"discounted_cash":115.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457062910","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"67457062910","type":"NDC"}],"standard_charges":[{"gross_charge":205.18,"discounted_cash":71.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082312","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"gross_charge":208.66,"discounted_cash":73.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082399","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"gross_charge":200.18,"discounted_cash":70.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082415","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082415","type":"NDC"}],"standard_charges":[{"gross_charge":250.39,"discounted_cash":87.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRASTUZUMAB-DKST FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457084550","type":"CDM"},{"code":"Q5114","type":"HCPCS"},{"code":"67457084550","type":"NDC"}],"standard_charges":[{"gross_charge":13710.8,"discounted_cash":4798.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457085350","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"67457085350","type":"NDC"}],"standard_charges":[{"gross_charge":410.48,"discounted_cash":143.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085500","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085500","type":"NDC"}],"standard_charges":[{"gross_charge":94.98,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457088799","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"67457088799","type":"NDC"}],"standard_charges":[{"gross_charge":101.26,"discounted_cash":35.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx67457092500","type":"CDM"},{"code":"67457092500","type":"NDC"}],"standard_charges":[{"gross_charge":881.6,"discounted_cash":308.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRASTUZUMAB-DKST FOR IV SOLN 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457099115","type":"CDM"},{"code":"Q5114","type":"HCPCS"},{"code":"67457099115","type":"NDC"}],"standard_charges":[{"gross_charge":4932.83,"discounted_cash":1726.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REGADENOSON IV INJ 0.4 MG/5ML (0.08 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67457099405","type":"CDM"},{"code":"J2785","type":"HCPCS"},{"code":"67457099405","type":"NDC"}],"standard_charges":[{"gross_charge":99.27,"discounted_cash":34.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67850003210","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"67850003210","type":"NDC"}],"standard_charges":[{"gross_charge":100.5,"discounted_cash":35.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67850015010","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"67850015010","type":"NDC"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877010501","type":"CDM"},{"code":"67877010501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":20.0,"type":"GM"},"code_information":[{"code":"Rx67877012420","type":"CDM"},{"code":"67877012420","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx67877012425","type":"CDM"},{"code":"67877012425","type":"NDC"}],"standard_charges":[{"gross_charge":9.52,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx67877012485","type":"CDM"},{"code":"67877012485","type":"NDC"}],"standard_charges":[{"gross_charge":23.97,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877014601","type":"CDM"},{"code":"67877014601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877015901","type":"CDM"},{"code":"67877015901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022201","type":"CDM"},{"code":"67877022201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022305","type":"CDM"},{"code":"67877022305","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022401","type":"CDM"},{"code":"67877022401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022501","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"67877022501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877024901","type":"CDM"},{"code":"67877024901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx67877025115","type":"CDM"},{"code":"67877025115","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":80.0,"type":"GM"},"code_information":[{"code":"Rx67877025180","type":"CDM"},{"code":"67877025180","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877026601","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"67877026601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877027690","type":"CDM"},{"code":"67877027690","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877029601","type":"CDM"},{"code":"67877029601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877032001","type":"CDM"},{"code":"67877032001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041401","type":"CDM"},{"code":"67877041401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041901","type":"CDM"},{"code":"67877041901","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":5.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041920","type":"CDM"},{"code":"67877041920","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041984","type":"CDM"},{"code":"67877041984","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877042612","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"67877042612","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ITRACONAZOLE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877045430","type":"CDM"},{"code":"67877045430","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049090","type":"CDM"},{"code":"67877049090","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049160","type":"CDM"},{"code":"67877049160","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877050330","type":"CDM"},{"code":"67877050330","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67877054588","type":"CDM"},{"code":"67877054588","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877056105","type":"CDM"},{"code":"67877056105","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877058901","type":"CDM"},{"code":"67877058901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877059201","type":"CDM"},{"code":"67877059201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOLVAPTAN TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877063602","type":"CDM"},{"code":"67877063602","type":"NDC"}],"standard_charges":[{"gross_charge":125.9,"discounted_cash":44.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LURASIDONE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877063830","type":"CDM"},{"code":"67877063830","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LURASIDONE HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877064130","type":"CDM"},{"code":"67877064130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DROXIDOPA CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877070590","type":"CDM"},{"code":"67877070590","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SIROLIMUS TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877074601","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"67877074601","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALVIMOPAN CAP 12 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67919002010","type":"CDM"},{"code":"67919002010","type":"NDC"}],"standard_charges":[{"gross_charge":272.76,"discounted_cash":95.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTOLOZANE-TAZOBACTAM FOR INJ 1.5 GM (1-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67919003001","type":"CDM"},{"code":"J0695","type":"HCPCS"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"gross_charge":1854.44,"discounted_cash":649.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB ER 12HR 0.375 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68047025501","type":"CDM"},{"code":"68047025501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IRBESARTAN TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084000711","type":"CDM"},{"code":"68084000711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002201","type":"CDM"},{"code":"68084002201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002211","type":"CDM"},{"code":"68084002211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002701","type":"CDM"},{"code":"68084002701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002711","type":"CDM"},{"code":"68084002711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002911","type":"CDM"},{"code":"68084002911","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084003101","type":"CDM"},{"code":"68084003101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084003111","type":"CDM"},{"code":"68084003111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084003201","type":"CDM"},{"code":"68084003201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084003211","type":"CDM"},{"code":"68084003211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004101","type":"CDM"},{"code":"68084004101","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004111","type":"CDM"},{"code":"68084004111","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004401","type":"CDM"},{"code":"68084004401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004411","type":"CDM"},{"code":"68084004411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004511","type":"CDM"},{"code":"68084004511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005301","type":"CDM"},{"code":"68084005301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005311","type":"CDM"},{"code":"68084005311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005401","type":"CDM"},{"code":"68084005401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005411","type":"CDM"},{"code":"68084005411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084006211","type":"CDM"},{"code":"68084006211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084006411","type":"CDM"},{"code":"68084006411","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007011","type":"CDM"},{"code":"68084007011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 750 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007101","type":"CDM"},{"code":"68084007101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 750 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007111","type":"CDM"},{"code":"68084007111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRETINOIN CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007511","type":"CDM"},{"code":"68084007511","type":"NDC"}],"standard_charges":[{"gross_charge":38.27,"discounted_cash":13.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084008211","type":"CDM"},{"code":"68084008211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084008301","type":"CDM"},{"code":"68084008301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084008311","type":"CDM"},{"code":"68084008311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009311","type":"CDM"},{"code":"68084009311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009711","type":"CDM"},{"code":"68084009711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009801","type":"CDM"},{"code":"68084009801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009811","type":"CDM"},{"code":"68084009811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009901","type":"CDM"},{"code":"68084009901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009911","type":"CDM"},{"code":"68084009911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084010911","type":"CDM"},{"code":"68084010911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084011101","type":"CDM"},{"code":"68084011101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLIPIZIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084011111","type":"CDM"},{"code":"68084011111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084015401","type":"CDM"},{"code":"68084015401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084015411","type":"CDM"},{"code":"68084015411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084015801","type":"CDM"},{"code":"68084015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084016601","type":"CDM"},{"code":"68084016601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084016611","type":"CDM"},{"code":"68084016611","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084017401","type":"CDM"},{"code":"68084017401","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084017411","type":"CDM"},{"code":"68084017411","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DRONABINOL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084017511","type":"CDM"},{"code":"68084017511","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018211","type":"CDM"},{"code":"68084018211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019611","type":"CDM"},{"code":"68084019611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019801","type":"CDM"},{"code":"68084019801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019811","type":"CDM"},{"code":"68084019811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020201","type":"CDM"},{"code":"68084020201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020211","type":"CDM"},{"code":"68084020211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020301","type":"CDM"},{"code":"68084020301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRIMIDONE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020311","type":"CDM"},{"code":"68084020311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020401","type":"CDM"},{"code":"68084020401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020411","type":"CDM"},{"code":"68084020411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOXIDIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020501","type":"CDM"},{"code":"68084020501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOXIDIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020511","type":"CDM"},{"code":"68084020511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020601","type":"CDM"},{"code":"68084020601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020611","type":"CDM"},{"code":"68084020611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021401","type":"CDM"},{"code":"68084021401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021411","type":"CDM"},{"code":"68084021411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084022901","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"68084022901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023011","type":"CDM"},{"code":"68084023011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024401","type":"CDM"},{"code":"68084024401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024411","type":"CDM"},{"code":"68084024411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025101","type":"CDM"},{"code":"68084025101","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025111","type":"CDM"},{"code":"68084025111","type":"NDC"}],"standard_charges":[{"gross_charge":6.98,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025401","type":"CDM"},{"code":"68084025401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025411","type":"CDM"},{"code":"68084025411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025611","type":"CDM"},{"code":"68084025611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025621","type":"CDM"},{"code":"68084025621","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025911","type":"CDM"},{"code":"68084025911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026101","type":"CDM"},{"code":"68084026101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026111","type":"CDM"},{"code":"68084026111","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026311","type":"CDM"},{"code":"68084026311","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026901","type":"CDM"},{"code":"68084026901","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026911","type":"CDM"},{"code":"68084026911","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027211","type":"CDM"},{"code":"68084027211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027501","type":"CDM"},{"code":"68084027501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027511","type":"CDM"},{"code":"68084027511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027801","type":"CDM"},{"code":"68084027801","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028001","type":"CDM"},{"code":"68084028001","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028011","type":"CDM"},{"code":"68084028011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028111","type":"CDM"},{"code":"68084028111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028201","type":"CDM"},{"code":"68084028201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 50-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028211","type":"CDM"},{"code":"68084028211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084028401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028411","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084028411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028801","type":"CDM"},{"code":"68084028801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028811","type":"CDM"},{"code":"68084028811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029201","type":"CDM"},{"code":"68084029201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029211","type":"CDM"},{"code":"68084029211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029301","type":"CDM"},{"code":"68084029301","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029311","type":"CDM"},{"code":"68084029311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029901","type":"CDM"},{"code":"68084029901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029911","type":"CDM"},{"code":"68084029911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030011","type":"CDM"},{"code":"68084030011","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030021","type":"CDM"},{"code":"68084030021","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030101","type":"CDM"},{"code":"68084030101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030111","type":"CDM"},{"code":"68084030111","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030611","type":"CDM"},{"code":"68084030611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030711","type":"CDM"},{"code":"68084030711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031111","type":"CDM"},{"code":"68084031111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031301","type":"CDM"},{"code":"68084031301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031311","type":"CDM"},{"code":"68084031311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031711","type":"CDM"},{"code":"68084031711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031911","type":"CDM"},{"code":"68084031911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032811","type":"CDM"},{"code":"68084032811","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032821","type":"CDM"},{"code":"68084032821","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033301","type":"CDM"},{"code":"68084033301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033311","type":"CDM"},{"code":"68084033311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVETIRACETAM TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084033811","type":"CDM"},{"code":"68084033811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034201","type":"CDM"},{"code":"68084034201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034211","type":"CDM"},{"code":"68084034211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOPIRAMATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034301","type":"CDM"},{"code":"68084034301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034601","type":"CDM"},{"code":"68084034601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034611","type":"CDM"},{"code":"68084034611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034701","type":"CDM"},{"code":"68084034701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034711","type":"CDM"},{"code":"68084034711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035411","type":"CDM"},{"code":"68084035411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035711","type":"CDM"},{"code":"68084035711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037201","type":"CDM"},{"code":"68084037201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037211","type":"CDM"},{"code":"68084037211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037301","type":"CDM"},{"code":"68084037301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037311","type":"CDM"},{"code":"68084037311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037421","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084037421","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084039711","type":"CDM"},{"code":"68084039711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040001","type":"CDM"},{"code":"68084040001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040011","type":"CDM"},{"code":"68084040011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040411","type":"CDM"},{"code":"68084040411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084041501","type":"CDM"},{"code":"68084041501","type":"NDC"}],"standard_charges":[{"gross_charge":2.46,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084041511","type":"CDM"},{"code":"68084041511","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084043511","type":"CDM"},{"code":"68084043511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084043711","type":"CDM"},{"code":"68084043711","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084043765","type":"CDM"},{"code":"68084043765","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044001","type":"CDM"},{"code":"68084044001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044011","type":"CDM"},{"code":"68084044011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044601","type":"CDM"},{"code":"68084044601","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044611","type":"CDM"},{"code":"68084044611","type":"NDC"}],"standard_charges":[{"gross_charge":3.19,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044901","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084044901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044911","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084044911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045001","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045001","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045011","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045011","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045101","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045101","type":"NDC"}],"standard_charges":[{"gross_charge":11.13,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045111","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045111","type":"NDC"}],"standard_charges":[{"gross_charge":13.74,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045911","type":"CDM"},{"code":"68084045911","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045921","type":"CDM"},{"code":"68084045921","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIDOVUDINE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084046211","type":"CDM"},{"code":"68084046211","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084046301","type":"CDM"},{"code":"68084046301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084046311","type":"CDM"},{"code":"68084046311","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084046901","type":"CDM"},{"code":"68084046901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084046911","type":"CDM"},{"code":"68084046911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047301","type":"CDM"},{"code":"68084047301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047311","type":"CDM"},{"code":"68084047311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047901","type":"CDM"},{"code":"68084047901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047911","type":"CDM"},{"code":"68084047911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048101","type":"CDM"},{"code":"68084048101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048111","type":"CDM"},{"code":"68084048111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048201","type":"CDM"},{"code":"68084048201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048211","type":"CDM"},{"code":"68084048211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048711","type":"CDM"},{"code":"68084048711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049401","type":"CDM"},{"code":"68084049401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049411","type":"CDM"},{"code":"68084049411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084049711","type":"CDM"},{"code":"68084049711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050211","type":"CDM"},{"code":"68084050211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050301","type":"CDM"},{"code":"68084050301","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050311","type":"CDM"},{"code":"68084050311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050401","type":"CDM"},{"code":"68084050401","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050411","type":"CDM"},{"code":"68084050411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050511","type":"CDM"},{"code":"68084050511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084050611","type":"CDM"},{"code":"68084050611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084052511","type":"CDM"},{"code":"68084052511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053101","type":"CDM"},{"code":"68084053101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053111","type":"CDM"},{"code":"68084053111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053901","type":"CDM"},{"code":"68084053901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053911","type":"CDM"},{"code":"68084053911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084054211","type":"CDM"},{"code":"68084054211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TEMAZEPAM CAP 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084054921","type":"CDM"},{"code":"68084054921","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOVASTATIN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084055911","type":"CDM"},{"code":"68084055911","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOVASTATIN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056001","type":"CDM"},{"code":"68084056001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059025","type":"CDM"},{"code":"68084059025","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 80 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059095","type":"CDM"},{"code":"68084059095","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059101","type":"CDM"},{"code":"68084059101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059111","type":"CDM"},{"code":"68084059111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059201","type":"CDM"},{"code":"68084059201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059211","type":"CDM"},{"code":"68084059211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059411","type":"CDM"},{"code":"68084059411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059701","type":"CDM"},{"code":"68084059701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059901","type":"CDM"},{"code":"68084059901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059911","type":"CDM"},{"code":"68084059911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060111","type":"CDM"},{"code":"68084060111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060311","type":"CDM"},{"code":"68084060311","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060321","type":"CDM"},{"code":"68084060321","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060511","type":"CDM"},{"code":"68084060511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060611","type":"CDM"},{"code":"68084060611","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060621","type":"CDM"},{"code":"68084060621","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060901","type":"CDM"},{"code":"68084060901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084060911","type":"CDM"},{"code":"68084060911","type":"NDC"}],"standard_charges":[{"gross_charge":9.27,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061101","type":"CDM"},{"code":"68084061101","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061111","type":"CDM"},{"code":"68084061111","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061211","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084061211","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061221","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084061221","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061711","type":"CDM"},{"code":"68084061711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061801","type":"CDM"},{"code":"68084061801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061811","type":"CDM"},{"code":"68084061811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061901","type":"CDM"},{"code":"68084061901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061911","type":"CDM"},{"code":"68084061911","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":2.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084063001","type":"CDM"},{"code":"68084063001","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084063011","type":"CDM"},{"code":"68084063011","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064001","type":"CDM"},{"code":"68084064001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065611","type":"CDM"},{"code":"68084065611","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065901","type":"CDM"},{"code":"68084065901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065911","type":"CDM"},{"code":"68084065911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084066601","type":"CDM"},{"code":"68084066601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067311","type":"CDM"},{"code":"68084067311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067511","type":"CDM"},{"code":"68084067511","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067521","type":"CDM"},{"code":"68084067521","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084068301","type":"CDM"},{"code":"68084068301","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084068311","type":"CDM"},{"code":"68084068311","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069201","type":"CDM"},{"code":"68084069201","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069211","type":"CDM"},{"code":"68084069211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069701","type":"CDM"},{"code":"68084069701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069711","type":"CDM"},{"code":"68084069711","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069801","type":"CDM"},{"code":"68084069801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069811","type":"CDM"},{"code":"68084069811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070311","type":"CDM"},{"code":"68084070311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070901","type":"CDM"},{"code":"68084070901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084072801","type":"CDM"},{"code":"68084072801","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OLANZAPINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084074001","type":"CDM"},{"code":"68084074001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084074201","type":"CDM"},{"code":"68084074201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084075325","type":"CDM"},{"code":"68084075325","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084075395","type":"CDM"},{"code":"68084075395","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077611","type":"CDM"},{"code":"68084077611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080521","type":"CDM"},{"code":"68084080521","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080801","type":"CDM"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084081311","type":"CDM"},{"code":"68084081311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082321","type":"CDM"},{"code":"68084082321","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085601","type":"CDM"},{"code":"68084085601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087925","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"68084087925","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087995","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"68084087995","type":"NDC"}],"standard_charges":[{"gross_charge":4.67,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084090711","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"68084090711","type":"NDC"}],"standard_charges":[{"gross_charge":4.06,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084090721","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"68084090721","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SIROLIMUS TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084091525","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"68084091525","type":"NDC"}],"standard_charges":[{"gross_charge":13.09,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SIROLIMUS TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084091595","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"68084091595","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084092825","type":"CDM"},{"code":"68084092825","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084092932","type":"CDM"},{"code":"68084092932","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPYLTHIOURACIL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096425","type":"CDM"},{"code":"68084096425","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096611","type":"CDM"},{"code":"68084096611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096801","type":"CDM"},{"code":"68084096801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096811","type":"CDM"},{"code":"68084096811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084097495","type":"CDM"},{"code":"68084097495","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094000159","type":"CDM"},{"code":"68094000159","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094000162","type":"CDM"},{"code":"68094000162","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094006359","type":"CDM"},{"code":"68094006359","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094019359","type":"CDM"},{"code":"68094019359","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094021459","type":"CDM"},{"code":"68094021459","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094025061","type":"CDM"},{"code":"68094025061","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094030159","type":"CDM"},{"code":"68094030159","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094052859","type":"CDM"},{"code":"68094052859","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094052861","type":"CDM"},{"code":"68094052861","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094052862","type":"CDM"},{"code":"68094052862","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094076359","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"68094076359","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":5.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076459","type":"CDM"},{"code":"68094076459","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076462","type":"CDM"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":4.48,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180013415","type":"CDM"},{"code":"68180013415","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180015901","type":"CDM"},{"code":"68180015901","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180016006","type":"CDM"},{"code":"68180016006","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFIXIME FOR SUSP 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68180020203","type":"CDM"},{"code":"68180020203","type":"NDC"}],"standard_charges":[{"gross_charge":31.7,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180021009","type":"CDM"},{"code":"68180021009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180023007","type":"CDM"},{"code":"68180023007","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180028101","type":"CDM"},{"code":"68180028101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029407","type":"CDM"},{"code":"68180029407","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029506","type":"CDM"},{"code":"68180029506","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029509","type":"CDM"},{"code":"68180029509","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 60 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029606","type":"CDM"},{"code":"68180029606","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030260","type":"CDM"},{"code":"68180030260","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030360","type":"CDM"},{"code":"68180030360","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180031101","type":"CDM"},{"code":"68180031101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180031906","type":"CDM"},{"code":"68180031906","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180031909","type":"CDM"},{"code":"68180031909","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180035309","type":"CDM"},{"code":"68180035309","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180035407","type":"CDM"},{"code":"68180035407","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180036209","type":"CDM"},{"code":"68180036209","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180036309","type":"CDM"},{"code":"68180036309","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180050101","type":"CDM"},{"code":"68180050101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051201","type":"CDM"},{"code":"68180051201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051301","type":"CDM"},{"code":"68180051301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051701","type":"CDM"},{"code":"68180051701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LAMIVUDINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180060207","type":"CDM"},{"code":"68180060207","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180065001","type":"CDM"},{"code":"68180065001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067511","type":"CDM"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067711","type":"CDM"},{"code":"68180067711","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFDINIR FOR SUSP 250 MG/5ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx68180072320","type":"CDM"},{"code":"68180072320","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SILODOSIN CAP 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180074006","type":"CDM"},{"code":"68180074006","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 500 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180081942","type":"CDM"},{"code":"68180081942","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 1000 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180082110","type":"CDM"},{"code":"68180082110","type":"NDC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":5.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 1000 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180082147","type":"CDM"},{"code":"68180082147","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096509","type":"CDM"},{"code":"68180096509","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096601","type":"CDM"},{"code":"68180096601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096609","type":"CDM"},{"code":"68180096609","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180097901","type":"CDM"},{"code":"68180097901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180098001","type":"CDM"},{"code":"68180098001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180098101","type":"CDM"},{"code":"68180098101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx68308015215","type":"CDM"},{"code":"68308015215","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx68308015230","type":"CDM"},{"code":"68308015230","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx68308015260","type":"CDM"},{"code":"68308015260","type":"NDC"}],"standard_charges":[{"gross_charge":33.03,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ERYTHROMYCIN W/ DELAYED RELEASE PARTICLES CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68308025010","type":"CDM"},{"code":"68308025010","type":"NDC"}],"standard_charges":[{"gross_charge":6.67,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68308050547","type":"CDM"},{"code":"68308050547","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382002001","type":"CDM"},{"code":"68382002001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382003416","type":"CDM"},{"code":"68382003416","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382007901","type":"CDM"},{"code":"68382007901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009201","type":"CDM"},{"code":"68382009201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009301","type":"CDM"},{"code":"68382009301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009401","type":"CDM"},{"code":"68382009401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009501","type":"CDM"},{"code":"68382009501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382011214","type":"CDM"},{"code":"68382011214","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382011414","type":"CDM"},{"code":"68382011414","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382013506","type":"CDM"},{"code":"68382013506","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382013516","type":"CDM"},{"code":"68382013516","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382013814","type":"CDM"},{"code":"68382013814","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOPIRAMATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382013914","type":"CDM"},{"code":"68382013914","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382018001","type":"CDM"},{"code":"68382018001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382018101","type":"CDM"},{"code":"68382018101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382018701","type":"CDM"},{"code":"68382018701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382019716","type":"CDM"},{"code":"68382019716","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382019816","type":"CDM"},{"code":"68382019816","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382022714","type":"CDM"},{"code":"68382022714","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382024701","type":"CDM"},{"code":"68382024701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382025501","type":"CDM"},{"code":"68382025501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382030930","type":"CDM"},{"code":"68382030930","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031601","type":"CDM"},{"code":"68382031601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382031818","type":"CDM"},{"code":"68382031818","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EXEMESTANE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382038306","type":"CDM"},{"code":"68382038306","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382052960","type":"CDM"},{"code":"68382052960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382059516","type":"CDM"},{"code":"68382059516","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382065906","type":"CDM"},{"code":"68382065906","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382066001","type":"CDM"},{"code":"68382066001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382072001","type":"CDM"},{"code":"68382072001","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382072216","type":"CDM"},{"code":"68382072216","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382077501","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"68382077501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382079101","type":"CDM"},{"code":"68382079101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382079801","type":"CDM"},{"code":"68382079801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68382086010","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"gross_charge":179.74,"discounted_cash":62.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382091001","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"68382091001","type":"NDC"}],"standard_charges":[{"gross_charge":240.43,"discounted_cash":84.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382091010","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"gross_charge":162.87,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462010130","type":"CDM"},{"code":"68462010130","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462010230","type":"CDM"},{"code":"68462010230","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462010340","type":"CDM"},{"code":"68462010340","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462010430","type":"CDM"},{"code":"68462010430","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015713","type":"CDM"},{"code":"68462015713","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015740","type":"CDM"},{"code":"68462015740","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462016201","type":"CDM"},{"code":"68462016201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462016205","type":"CDM"},{"code":"68462016205","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462016501","type":"CDM"},{"code":"68462016501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462018801","type":"CDM"},{"code":"68462018801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462023301","type":"CDM"},{"code":"68462023301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462025401","type":"CDM"},{"code":"68462025401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026001","type":"CDM"},{"code":"68462026001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026390","type":"CDM"},{"code":"68462026390","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029301","type":"CDM"},{"code":"68462029301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462030201","type":"CDM"},{"code":"68462030201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NORETHINDRONE ACETATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462030450","type":"CDM"},{"code":"68462030450","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462033290","type":"CDM"},{"code":"68462033290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COLESEVELAM HCL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462043318","type":"CDM"},{"code":"68462043318","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462047054","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462047054","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062154","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062154","type":"NDC"}],"standard_charges":[{"gross_charge":95.14,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062210","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062210","type":"NDC"}],"standard_charges":[{"gross_charge":95.18,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062264","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062264","type":"NDC"}],"standard_charges":[{"gross_charge":95.59,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRETINOIN CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462079201","type":"CDM"},{"code":"68462079201","type":"NDC"}],"standard_charges":[{"gross_charge":15.94,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68516521400","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68516521400","type":"NDC"}],"standard_charges":[{"gross_charge":352.8,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68516521401","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68516521401","type":"NDC"}],"standard_charges":[{"gross_charge":352.8,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68516521402","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68516521402","type":"NDC"}],"standard_charges":[{"gross_charge":352.8,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx68516521408","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"68516521408","type":"NDC"}],"standard_charges":[{"gross_charge":512.4,"discounted_cash":179.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521601","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521601","type":"NDC"}],"standard_charges":[{"gross_charge":353.36,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521602","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":353.92,"discounted_cash":123.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 40 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68546032506","type":"CDM"},{"code":"J1595","type":"HCPCS"},{"code":"68546032506","type":"NDC"}],"standard_charges":[{"gross_charge":4716.64,"discounted_cash":1650.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682001110","type":"CDM"},{"code":"68682001110","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682030210","type":"CDM"},{"code":"68682030210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL-CLIDINIUM BROMIDE CAP 5-2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682040910","type":"CDM"},{"code":"68682040910","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68788676909","type":"CDM"},{"code":"68788676909","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68788900409","type":"CDM"},{"code":"68788900409","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRYPAN BLUE INTRAOCULAR SOLN PREF SYR 0.06%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68803061210","type":"CDM"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"gross_charge":75.82,"discounted_cash":26.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68817013450","type":"CDM"},{"code":"J9264","type":"HCPCS"},{"code":"68817013450","type":"NDC"}],"standard_charges":[{"gross_charge":15019.93,"discounted_cash":5256.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ETHAMBUTOL HCL TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68850001202","type":"CDM"},{"code":"68850001202","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026101","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026101","type":"NDC"}],"standard_charges":[{"gross_charge":8758.4,"discounted_cash":3065.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026102","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026102","type":"NDC"}],"standard_charges":[{"gross_charge":19040.0,"discounted_cash":6664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MILTEFOSINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69051030001","type":"CDM"},{"code":"69051030001","type":"NDC"}],"standard_charges":[{"gross_charge":72.55,"discounted_cash":25.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097012605","type":"CDM"},{"code":"69097012605","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097015812","type":"CDM"},{"code":"69097015812","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097042207","type":"CDM"},{"code":"69097042207","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097057967","type":"CDM"},{"code":"69097057967","type":"NDC"}],"standard_charges":[{"gross_charge":34.32,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EMTRICITABINE CAPS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097064202","type":"CDM"},{"code":"69097064202","type":"NDC"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097067805","type":"CDM"},{"code":"69097067805","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69097070996","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097070996","type":"NDC"}],"standard_charges":[{"gross_charge":94.85,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097082103","type":"CDM"},{"code":"69097082103","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097082502","type":"CDM"},{"code":"69097082502","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097083305","type":"CDM"},{"code":"69097083305","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097084607","type":"CDM"},{"code":"69097084607","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBINAFINE HCL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097085902","type":"CDM"},{"code":"69097085902","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TERBINAFINE HCL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097085907","type":"CDM"},{"code":"69097085907","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097087502","type":"CDM"},{"code":"69097087502","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 500 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097093498","type":"CDM"},{"code":"69097093498","type":"NDC"}],"standard_charges":[{"gross_charge":5.77,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LANTHANUM CARBONATE CHEW TAB 1000 MG (ELEMENTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097093698","type":"CDM"},{"code":"69097093698","type":"NDC"}],"standard_charges":[{"gross_charge":7.64,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097096507","type":"CDM"},{"code":"69097096507","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097096793","type":"CDM"},{"code":"69097096793","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238110205","type":"CDM"},{"code":"69238110205","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238126401","type":"CDM"},{"code":"69238126401","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131009","type":"CDM"},{"code":"69238131009","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131109","type":"CDM"},{"code":"69238131109","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131209","type":"CDM"},{"code":"69238131209","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238148901","type":"CDM"},{"code":"69238148901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238154401","type":"CDM"},{"code":"69238154401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238160502","type":"CDM"},{"code":"69238160502","type":"NDC"}],"standard_charges":[{"gross_charge":23.01,"discounted_cash":8.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238161701","type":"CDM"},{"code":"69238161701","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOCAPROIC ACID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238163703","type":"CDM"},{"code":"69238163703","type":"NDC"}],"standard_charges":[{"gross_charge":4.78,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx69238201603","type":"CDM"},{"code":"69238201603","type":"NDC"}],"standard_charges":[{"gross_charge":26.14,"discounted_cash":9.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238207901","type":"CDM"},{"code":"69238207901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238208101","type":"CDM"},{"code":"69238208101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315011601","type":"CDM"},{"code":"69315011601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315013701","type":"CDM"},{"code":"69315013701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx69315030615","type":"CDM"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"gross_charge":7.42,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69315030805","type":"CDM"},{"code":"69315030805","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69315050447","type":"CDM"},{"code":"69315050447","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69315050460","type":"CDM"},{"code":"69315050460","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090401","type":"CDM"},{"code":"69315090401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090501","type":"CDM"},{"code":"69315090501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315091001","type":"CDM"},{"code":"69315091001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69339013634","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"gross_charge":131.34,"discounted_cash":45.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367016204","type":"CDM"},{"code":"69367016204","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367016304","type":"CDM"},{"code":"69367016304","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367026501","type":"CDM"},{"code":"69367026501","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367034001","type":"CDM"},{"code":"69367034001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69374030210","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"69374030210","type":"NDC"}],"standard_charges":[{"gross_charge":93.63,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx69374031410","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"69374031410","type":"NDC"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":116.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx69374094604","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"69374094604","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx69374095350","type":"CDM"},{"code":"69374095350","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69374095710","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"69374095710","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROIC ACID CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452015020","type":"CDM"},{"code":"69452015020","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452024120","type":"CDM"},{"code":"69452024120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452027120","type":"CDM"},{"code":"69452027120","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69543045101","type":"CDM"},{"code":"69543045101","type":"NDC"}],"standard_charges":[{"gross_charge":3.86,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69543045110","type":"CDM"},{"code":"69543045110","type":"NDC"}],"standard_charges":[{"gross_charge":3.86,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69584011110","type":"CDM"},{"code":"69584011110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx69680011201","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"69680011201","type":"NDC"}],"standard_charges":[{"gross_charge":93.54,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx69680011225","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"gross_charge":93.38,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOCAPROIC ACID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69680011530","type":"CDM"},{"code":"69680011530","type":"NDC"}],"standard_charges":[{"gross_charge":8.32,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx69784023110","type":"CDM"},{"code":"69784023110","type":"NDC"}],"standard_charges":[{"gross_charge":182.56,"discounted_cash":63.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69918030130","type":"CDM"},{"code":"69918030130","type":"NDC"}],"standard_charges":[{"gross_charge":6.06,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01%","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx69918050105","type":"CDM"},{"code":"69918050105","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69918073501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69918073501","type":"NDC"}],"standard_charges":[{"gross_charge":119.71,"discounted_cash":41.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69918073510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69918073510","type":"NDC"}],"standard_charges":[{"gross_charge":119.76,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE CAP 50-300-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010004401","type":"CDM"},{"code":"70010004401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010006301","type":"CDM"},{"code":"70010006301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010075401","type":"CDM"},{"code":"70010075401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010078001","type":"CDM"},{"code":"70010078001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010078612","type":"CDM"},{"code":"70010078612","type":"NDC"}],"standard_charges":[{"gross_charge":19.56,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML,DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,DEXAMETHASONE SOD PHOS INJ SOL PREF SYR 10 MG/ML (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069002101","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002101","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML,DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,DEXAMETHASONE SOD PHOS INJ SOL PREF SYR 10 MG/ML (PF)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx70069002101","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002101","type":"NDC"}],"standard_charges":[{"gross_charge":93.74,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx70069002125","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":93.54,"discounted_cash":32.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069005101","type":"CDM"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006701","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006701","type":"NDC"}],"standard_charges":[{"gross_charge":93.87,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006710","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006710","type":"NDC"}],"standard_charges":[{"gross_charge":93.87,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006725","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006725","type":"NDC"}],"standard_charges":[{"gross_charge":94.42,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069007201","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007201","type":"NDC"}],"standard_charges":[{"gross_charge":94.16,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069007210","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007210","type":"NDC"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":34.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70069012101","type":"CDM"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx70069013101","type":"CDM"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx70069015101","type":"CDM"},{"code":"70069015101","type":"NDC"}],"standard_charges":[{"gross_charge":95.57,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx70069015110","type":"CDM"},{"code":"70069015110","type":"NDC"}],"standard_charges":[{"gross_charge":94.09,"discounted_cash":32.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027101","type":"CDM"},{"code":"70069027101","type":"NDC"}],"standard_charges":[{"gross_charge":96.03,"discounted_cash":33.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027125","type":"CDM"},{"code":"70069027125","type":"NDC"}],"standard_charges":[{"gross_charge":94.34,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069036201","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"70069036201","type":"NDC"}],"standard_charges":[{"gross_charge":96.87,"discounted_cash":33.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069036210","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"70069036210","type":"NDC"}],"standard_charges":[{"gross_charge":96.74,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL 125 MG/125ML IN DEXTROSE 5% IV SOLN (1 MG/ML)","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx70092100736","type":"CDM"},{"code":"70092100736","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70092100944","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"70092100944","type":"NDC"}],"standard_charges":[{"gross_charge":95.37,"discounted_cash":33.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-SODIUM CHLORIDE IV SOLN 1 GM/100ML-0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092101403","type":"CDM"},{"code":"70092101403","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092103036","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"70092103036","type":"NDC"}],"standard_charges":[{"gross_charge":280.92,"discounted_cash":98.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70092104646","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092104646","type":"NDC"}],"standard_charges":[{"gross_charge":93.77,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":55.0,"type":"ML"},"code_information":[{"code":"Rx70092110050","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70092110050","type":"NDC"}],"standard_charges":[{"gross_charge":149.85,"discounted_cash":52.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 20 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092111536","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"70092111536","type":"NDC"}],"standard_charges":[{"gross_charge":179.24,"discounted_cash":62.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 150 MG/150ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70092111850","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"70092111850","type":"NDC"}],"standard_charges":[{"gross_charge":215.2,"discounted_cash":75.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL-NACL SOLN PREF SY 50 MG/5ML-0.9% (10MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70092111944","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092111944","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL-BUPIVACAINE 2 MCG-0.1 %,FENTANYL 0.2 MG/100ML-BUPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.5 MG/250ML-BUPIV 0.1%-NACL 0.9% PF EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx70092116037","type":"CDM"},{"code":"70092116037","type":"NDC"}],"standard_charges":[{"gross_charge":215.2,"discounted_cash":75.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092141836","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"70092141836","type":"NDC"}],"standard_charges":[{"gross_charge":244.96,"discounted_cash":85.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROPIV-EPI-CLONID-KETOROLAC PREF SYR 123-0.25-0.04-15 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70092143350","type":"CDM"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":607.6,"discounted_cash":212.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx70092147550","type":"CDM"},{"code":"70092147550","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":55.0,"type":"ML"},"code_information":[{"code":"Rx70092149550","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70092149550","type":"NDC"}],"standard_charges":[{"gross_charge":184.63,"discounted_cash":64.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DILTIAZEM HCL 125 MG/125ML IN DEXTROSE 5% IV SOLN (1 MG/ML)","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx70092157536","type":"CDM"},{"code":"70092157536","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOLN PREF SYR 10 MCG/ML,EPINEPHRINE HCL-NACL IV SOLN PREF SYR 50 MCG/5ML-0.9%,EPINEPHRINE HCL-NACL IV SOLN PREF SYR 100 MCG/10ML-0.9%,EPINEPHRINE HCL-NACL IV SOL PREF SYR 200 MCG/20ML-0.9%,EPINEPHRINE HCL-NACL IV SOL PREF SYR 500 MCG/50ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 0.1 MG/10ML (10 MCG/ML),EPINEPHRINE-DEXTROSE IV SOLN PREF SYR 100 MCG/10ML-5%,EPINEPHRINE BITART-NACL IV SOLN PREF SYR 100 MCG/10ML-0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70092161746","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"70092161746","type":"NDC"}],"standard_charges":[{"gross_charge":99.18,"discounted_cash":34.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOCYANINE GREEN FOR IV SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70100042401","type":"CDM"},{"code":"70100042401","type":"NDC"}],"standard_charges":[{"gross_charge":1629.23,"discounted_cash":570.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOCYANINE GREEN FOR IV SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70100042402","type":"CDM"},{"code":"70100042402","type":"NDC"}],"standard_charges":[{"gross_charge":1629.23,"discounted_cash":570.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOCYANINE GREEN FOR INJ SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70100082502","type":"CDM"},{"code":"70100082502","type":"NDC"}],"standard_charges":[{"gross_charge":2118.89,"discounted_cash":741.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121104905","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121104905","type":"NDC"}],"standard_charges":[{"gross_charge":94.12,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121116801","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121116801","type":"NDC"}],"standard_charges":[{"gross_charge":94.17,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70121123801","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"70121123801","type":"NDC"}],"standard_charges":[{"gross_charge":729.95,"discounted_cash":255.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70121123901","type":"CDM"},{"code":"J9075","type":"HCPCS"},{"code":"70121123901","type":"NDC"}],"standard_charges":[{"gross_charge":907.9,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121156801","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121156801","type":"NDC"}],"standard_charges":[{"gross_charge":1049.1,"discounted_cash":367.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx70121157401","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"gross_charge":97.55,"discounted_cash":34.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx70121157405","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157405","type":"NDC"}],"standard_charges":[{"gross_charge":97.55,"discounted_cash":34.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70121157601","type":"CDM"},{"code":"70121157601","type":"NDC"}],"standard_charges":[{"gross_charge":100.48,"discounted_cash":35.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70121157607","type":"CDM"},{"code":"70121157607","type":"NDC"}],"standard_charges":[{"gross_charge":96.47,"discounted_cash":33.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157801","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157801","type":"NDC"}],"standard_charges":[{"gross_charge":100.48,"discounted_cash":35.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157807","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157807","type":"NDC"}],"standard_charges":[{"gross_charge":95.14,"discounted_cash":33.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70121164707","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"70121164707","type":"NDC"}],"standard_charges":[{"gross_charge":218.57,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121172001","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"70121172001","type":"NDC"}],"standard_charges":[{"gross_charge":243.1,"discounted_cash":85.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121172009","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"70121172009","type":"NDC"}],"standard_charges":[{"gross_charge":242.6,"discounted_cash":84.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70121230901","type":"CDM"},{"code":"70121230901","type":"NDC"}],"standard_charges":[{"gross_charge":100.5,"discounted_cash":35.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70121230907","type":"CDM"},{"code":"70121230907","type":"NDC"}],"standard_charges":[{"gross_charge":99.83,"discounted_cash":34.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BACLOFEN INTRATHECAL INJ 0.05 MG/ML (50 MCG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70257056255","type":"CDM"},{"code":"J0476","type":"HCPCS"},{"code":"70257056255","type":"NDC"}],"standard_charges":[{"gross_charge":184.63,"discounted_cash":64.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377001611","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"70377001611","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377006012","type":"CDM"},{"code":"70377006012","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LABETALOL HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377006112","type":"CDM"},{"code":"70377006112","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377011412","type":"CDM"},{"code":"70377011412","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377011512","type":"CDM"},{"code":"70377011512","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436000406","type":"CDM"},{"code":"70436000406","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436001982","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":95.47,"discounted_cash":33.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002182","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"gross_charge":96.17,"discounted_cash":33.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70436002780","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"70436002780","type":"NDC"}],"standard_charges":[{"gross_charge":632.8,"discounted_cash":221.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70436002880","type":"CDM"},{"code":"70436002880","type":"NDC"}],"standard_charges":[{"gross_charge":201.71,"discounted_cash":70.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GANCICLOVIR SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436008955","type":"CDM"},{"code":"J1570","type":"HCPCS"},{"code":"70436008955","type":"NDC"}],"standard_charges":[{"gross_charge":323.99,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436011056","type":"CDM"},{"code":"70436011056","type":"NDC"}],"standard_charges":[{"gross_charge":490.11,"discounted_cash":171.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436011780","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"70436011780","type":"NDC"}],"standard_charges":[{"gross_charge":254.33,"discounted_cash":89.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436016601","type":"CDM"},{"code":"70436016601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436018301","type":"CDM"},{"code":"70436018301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436020201","type":"CDM"},{"code":"70436020201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70436020380","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"70436020380","type":"NDC"}],"standard_charges":[{"gross_charge":99.53,"discounted_cash":34.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70436020382","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"70436020382","type":"NDC"}],"standard_charges":[{"gross_charge":99.59,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461002503","type":"CDM"},{"code":"90653","type":"HCPCS"},{"code":"70461002503","type":"NDC"}],"standard_charges":[{"gross_charge":711.91,"discounted_cash":249.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461002504","type":"CDM"},{"code":"90653","type":"HCPCS"},{"code":"70461002504","type":"NDC"}],"standard_charges":[{"gross_charge":711.91,"discounted_cash":249.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INFLUENZA VIRUS VAC TISS-CULT SUBUNIT SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461065503","type":"CDM"},{"code":"90661","type":"HCPCS"},{"code":"70461065503","type":"NDC"}],"standard_charges":[{"gross_charge":285.15,"discounted_cash":99.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INFLUENZA VIRUS VAC TISS-CULT SUBUNIT SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461065504","type":"CDM"},{"code":"90661","type":"HCPCS"},{"code":"70461065504","type":"NDC"}],"standard_charges":[{"gross_charge":285.15,"discounted_cash":99.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 10 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594004801","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594004801","type":"NDC"}],"standard_charges":[{"gross_charge":207.98,"discounted_cash":72.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594004901","type":"CDM"},{"code":"70594004901","type":"NDC"}],"standard_charges":[{"gross_charge":116.48,"discounted_cash":40.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594004902","type":"CDM"},{"code":"70594004902","type":"NDC"}],"standard_charges":[{"gross_charge":97.83,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594009702","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"70594009702","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70594011202","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"70594011202","type":"NDC"}],"standard_charges":[{"gross_charge":205.12,"discounted_cash":71.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 400 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx70655008810","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"70655008810","type":"NDC"}],"standard_charges":[{"gross_charge":245.5,"discounted_cash":85.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx70700010615","type":"CDM"},{"code":"70700010615","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx70700010616","type":"CDM"},{"code":"70700010616","type":"NDC"}],"standard_charges":[{"gross_charge":33.48,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROGESTERONE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70700016201","type":"CDM"},{"code":"70700016201","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUTEROL SULFATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710106101","type":"CDM"},{"code":"70710106101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BETAMETHASONE DIPROPIONATE CREAM 0.05%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx70710123304","type":"CDM"},{"code":"70710123304","type":"NDC"}],"standard_charges":[{"gross_charge":51.57,"discounted_cash":18.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx70710147801","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":6166.27,"discounted_cash":2158.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710166701","type":"CDM"},{"code":"70710166701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710166801","type":"CDM"},{"code":"70710166801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710171001","type":"CDM"},{"code":"70710171001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN SUPPOS 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710185206","type":"CDM"},{"code":"70710185206","type":"NDC"}],"standard_charges":[{"gross_charge":238.11,"discounted_cash":83.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDOMETHACIN SUPPOS 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710185207","type":"CDM"},{"code":"70710185207","type":"NDC"}],"standard_charges":[{"gross_charge":238.11,"discounted_cash":83.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GOSERELIN ACETATE IMPLANT 3.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70720095036","type":"CDM"},{"code":"J9202","type":"HCPCS"},{"code":"70720095036","type":"NDC"}],"standard_charges":[{"gross_charge":11621.44,"discounted_cash":4067.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GOSERELIN ACETATE IMPLANT 10.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70720095130","type":"CDM"},{"code":"J9202","type":"HCPCS"},{"code":"70720095130","type":"NDC"}],"standard_charges":[{"gross_charge":31794.1,"discounted_cash":11127.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70752010710","type":"CDM"},{"code":"70752010710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx70752011303","type":"CDM"},{"code":"70752011303","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756000111","type":"CDM"},{"code":"70756000111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001111","type":"CDM"},{"code":"70756001111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756020111","type":"CDM"},{"code":"70756020111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756020211","type":"CDM"},{"code":"70756020211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756020311","type":"CDM"},{"code":"70756020311","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756021490","type":"CDM"},{"code":"70756021490","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756021590","type":"CDM"},{"code":"70756021590","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756040411","type":"CDM"},{"code":"70756040411","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756041111","type":"CDM"},{"code":"70756041111","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756041211","type":"CDM"},{"code":"70756041211","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756042911","type":"CDM"},{"code":"70756042911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70756061125","type":"CDM"},{"code":"70756061125","type":"NDC"}],"standard_charges":[{"gross_charge":93.66,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70756061182","type":"CDM"},{"code":"70756061182","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70756062925","type":"CDM"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":6.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064125","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064125","type":"NDC"}],"standard_charges":[{"gross_charge":93.44,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064185","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064185","type":"NDC"}],"standard_charges":[{"gross_charge":93.51,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064725","type":"CDM"},{"code":"70756064725","type":"NDC"}],"standard_charges":[{"gross_charge":93.4,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064825","type":"CDM"},{"code":"70756064825","type":"NDC"}],"standard_charges":[{"gross_charge":93.44,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064887","type":"CDM"},{"code":"70756064887","type":"NDC"}],"standard_charges":[{"gross_charge":93.3,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx70756065225","type":"CDM"},{"code":"70756065225","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70756065810","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70756065810","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70756065825","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70756065825","type":"NDC"}],"standard_charges":[{"gross_charge":94.07,"discounted_cash":32.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756070360","type":"CDM"},{"code":"70756070360","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COCAINE HCL NASAL SOLN 40 MG/ML (4%)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70839036204","type":"CDM"},{"code":"C9046","type":"HCPCS"},{"code":"70839036204","type":"NDC"}],"standard_charges":[{"gross_charge":382.44,"discounted_cash":133.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860010310","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":35.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010541","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70860010541","type":"NDC"}],"standard_charges":[{"gross_charge":96.85,"discounted_cash":33.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860012641","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"70860012641","type":"NDC"}],"standard_charges":[{"gross_charge":100.43,"discounted_cash":35.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860040210","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"70860040210","type":"NDC"}],"standard_charges":[{"gross_charge":486.89,"discounted_cash":170.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70860060110","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"70860060110","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860065105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860065105","type":"NDC"}],"standard_charges":[{"gross_charge":99.21,"discounted_cash":34.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860078405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860078405","type":"NDC"}],"standard_charges":[{"gross_charge":97.9,"discounted_cash":34.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954001910","type":"CDM"},{"code":"70954001910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PRAZOSIN HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954002110","type":"CDM"},{"code":"70954002110","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954006010","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"70954006010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DAPSONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954013510","type":"CDM"},{"code":"70954013510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DAPSONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954013520","type":"CDM"},{"code":"70954013520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DAPSONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954013610","type":"CDM"},{"code":"70954013610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954021210","type":"CDM"},{"code":"70954021210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70954025810","type":"CDM"},{"code":"70954025810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954027410","type":"CDM"},{"code":"70954027410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx70954031610","type":"CDM"},{"code":"70954031610","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PAROXETINE HCL ORAL SUSP 10 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70954031910","type":"CDM"},{"code":"70954031910","type":"NDC"}],"standard_charges":[{"gross_charge":11.39,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954044310","type":"CDM"},{"code":"70954044310","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954045520","type":"CDM"},{"code":"70954045520","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRAZINAMIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954048410","type":"CDM"},{"code":"70954048410","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PYRAZINAMIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954048430","type":"CDM"},{"code":"70954048430","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVOCARNITINE TAB 330 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954049210","type":"CDM"},{"code":"70954049210","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70954060010","type":"CDM"},{"code":"70954060010","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954066810","type":"CDM"},{"code":"70954066810","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71093013304","type":"CDM"},{"code":"71093013304","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARDIOPLEGIC SOLN W/ LIDOCAINE","drug_information":{"unit":1052.8,"type":"ML"},"code_information":[{"code":"Rx71285020201","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71285020201","type":"NDC"}],"standard_charges":[{"gross_charge":196.95,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288000630","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288000630","type":"NDC"}],"standard_charges":[{"gross_charge":101.41,"discounted_cash":35.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288001615","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"gross_charge":159.37,"discounted_cash":55.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002420","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002420","type":"NDC"}],"standard_charges":[{"gross_charge":101.23,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002421","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002421","type":"NDC"}],"standard_charges":[{"gross_charge":101.23,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288011310","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011310","type":"NDC"}],"standard_charges":[{"gross_charge":263.82,"discounted_cash":92.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016010","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"71288016010","type":"NDC"}],"standard_charges":[{"gross_charge":289.73,"discounted_cash":101.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016610","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016610","type":"NDC"}],"standard_charges":[{"gross_charge":225.85,"discounted_cash":79.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016750","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016750","type":"NDC"}],"standard_charges":[{"gross_charge":616.5,"discounted_cash":215.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REGADENOSON IV INJ 0.4 MG/5ML (0.08 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288020185","type":"CDM"},{"code":"J2785","type":"HCPCS"},{"code":"71288020185","type":"NDC"}],"standard_charges":[{"gross_charge":166.88,"discounted_cash":58.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020305","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020305","type":"NDC"}],"standard_charges":[{"gross_charge":93.43,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040211","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":93.68,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx71288040302","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"gross_charge":93.44,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041401","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041401","type":"NDC"}],"standard_charges":[{"gross_charge":93.76,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041403","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041403","type":"NDC"}],"standard_charges":[{"gross_charge":93.67,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288043383","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":96.67,"discounted_cash":33.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx71288043894","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043894","type":"NDC"}],"standard_charges":[{"gross_charge":126.02,"discounted_cash":44.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288050110","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"71288050110","type":"NDC"}],"standard_charges":[{"gross_charge":98.1,"discounted_cash":34.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288060011","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":94.26,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288070005","type":"CDM"},{"code":"71288070005","type":"NDC"}],"standard_charges":[{"gross_charge":94.54,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288070006","type":"CDM"},{"code":"71288070006","type":"NDC"}],"standard_charges":[{"gross_charge":93.78,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATRACURIUM BESYLATE PRESERVATIVE FREE (PF) IV SOLN 50 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288070105","type":"CDM"},{"code":"71288070105","type":"NDC"}],"standard_charges":[{"gross_charge":94.21,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx71288071910","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"71288071910","type":"NDC"}],"standard_charges":[{"gross_charge":94.42,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx71288071911","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"71288071911","type":"NDC"}],"standard_charges":[{"gross_charge":94.27,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx71288080651","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"71288080651","type":"NDC"}],"standard_charges":[{"gross_charge":314.36,"discounted_cash":110.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288080701","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080701","type":"NDC"}],"standard_charges":[{"gross_charge":96.21,"discounted_cash":33.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288080702","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080702","type":"NDC"}],"standard_charges":[{"gross_charge":94.1,"discounted_cash":32.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71839013701","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"71839013701","type":"NDC"}],"standard_charges":[{"gross_charge":467.56,"discounted_cash":163.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71839013710","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"71839013710","type":"NDC"}],"standard_charges":[{"gross_charge":128.36,"discounted_cash":44.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72078003502","type":"CDM"},{"code":"72078003502","type":"NDC"}],"standard_charges":[{"gross_charge":590.79,"discounted_cash":206.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205000490","type":"CDM"},{"code":"72205000490","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205001190","type":"CDM"},{"code":"72205001190","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205001290","type":"CDM"},{"code":"72205001290","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FEBUXOSTAT TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205002830","type":"CDM"},{"code":"72205002830","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205003960","type":"CDM"},{"code":"72205003960","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205004060","type":"CDM"},{"code":"72205004060","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72205010001","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"72205010001","type":"NDC"}],"standard_charges":[{"gross_charge":96.12,"discounted_cash":33.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205018301","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"72205018301","type":"NDC"}],"standard_charges":[{"gross_charge":237.61,"discounted_cash":83.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205028060","type":"CDM"},{"code":"72205028060","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011825","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx72266012401","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72266012401","type":"NDC"}],"standard_charges":[{"gross_charge":97.47,"discounted_cash":34.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266013101","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"72266013101","type":"NDC"}],"standard_charges":[{"gross_charge":230.16,"discounted_cash":80.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266016001","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"72266016001","type":"NDC"}],"standard_charges":[{"gross_charge":167.03,"discounted_cash":58.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266016010","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"72266016010","type":"NDC"}],"standard_charges":[{"gross_charge":124.93,"discounted_cash":43.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx72266019701","type":"CDM"},{"code":"72266019701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72266023401","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266023401","type":"NDC"}],"standard_charges":[{"gross_charge":94.15,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72266023425","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266023425","type":"NDC"}],"standard_charges":[{"gross_charge":94.15,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72266024205","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"72266024205","type":"NDC"}],"standard_charges":[{"gross_charge":143.66,"discounted_cash":50.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266024805","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"72266024805","type":"NDC"}],"standard_charges":[{"gross_charge":832.94,"discounted_cash":291.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266024901","type":"CDM"},{"code":"72266024901","type":"NDC"}],"standard_charges":[{"gross_charge":96.95,"discounted_cash":33.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"POLYMYXIN B SULFATE FOR INJ 500000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266024910","type":"CDM"},{"code":"72266024910","type":"NDC"}],"standard_charges":[{"gross_charge":97.03,"discounted_cash":33.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx72485010401","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"72485010401","type":"NDC"}],"standard_charges":[{"gross_charge":98.98,"discounted_cash":34.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485040310","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72485040310","type":"NDC"}],"standard_charges":[{"gross_charge":95.68,"discounted_cash":33.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041701","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041701","type":"NDC"}],"standard_charges":[{"gross_charge":98.1,"discounted_cash":34.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"gross_charge":95.93,"discounted_cash":33.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485042210","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"gross_charge":95.68,"discounted_cash":33.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485050401","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"72485050401","type":"NDC"}],"standard_charges":[{"gross_charge":94.58,"discounted_cash":33.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485050425","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"72485050425","type":"NDC"}],"standard_charges":[{"gross_charge":94.16,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE OTIC SUSP 0.3-0.1%","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx72485062513","type":"CDM"},{"code":"72485062513","type":"NDC"}],"standard_charges":[{"gross_charge":110.5,"discounted_cash":38.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"AMINOCAPROIC ACID INJ 250 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx72572001525","type":"CDM"},{"code":"J0281","type":"HCPCS"},{"code":"72572001525","type":"NDC"}],"standard_charges":[{"gross_charge":94.35,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572004010","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"72572004010","type":"NDC"}],"standard_charges":[{"gross_charge":94.76,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572004110","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"72572004110","type":"NDC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx72572005010","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"72572005010","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572006125","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"72572006125","type":"NDC"}],"standard_charges":[{"gross_charge":94.72,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx72572007401","type":"CDM"},{"code":"72572007401","type":"NDC"}],"standard_charges":[{"gross_charge":244.4,"discounted_cash":85.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx72572007401","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"72572007401","type":"NDC"}],"standard_charges":[{"gross_charge":244.4,"discounted_cash":85.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572010201","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"72572010201","type":"NDC"}],"standard_charges":[{"gross_charge":285.48,"discounted_cash":99.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012001","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012001","type":"NDC"}],"standard_charges":[{"gross_charge":93.47,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012025","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012025","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012201","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012201","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572012225","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012225","type":"NDC"}],"standard_charges":[{"gross_charge":93.56,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx72572015010","type":"CDM"},{"code":"72572015010","type":"NDC"}],"standard_charges":[{"gross_charge":94.33,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017025","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017025","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572022501","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"72572022501","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572022525","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"72572022525","type":"NDC"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx72572025525","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"72572025525","type":"NDC"}],"standard_charges":[{"gross_charge":94.02,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572026501","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"72572026501","type":"NDC"}],"standard_charges":[{"gross_charge":93.73,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572026525","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"72572026525","type":"NDC"}],"standard_charges":[{"gross_charge":93.73,"discounted_cash":32.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572032001","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"72572032001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572032010","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"72572032010","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572035410","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72572035410","type":"NDC"}],"standard_charges":[{"gross_charge":94.31,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037001","type":"NDC"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037025","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037025","type":"NDC"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":32.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572038025","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"72572038025","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041510","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041510","type":"NDC"}],"standard_charges":[{"gross_charge":97.03,"discounted_cash":33.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041601","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041601","type":"NDC"}],"standard_charges":[{"gross_charge":100.36,"discounted_cash":35.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx72572042001","type":"CDM"},{"code":"72572042001","type":"NDC"}],"standard_charges":[{"gross_charge":93.45,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx72572042010","type":"CDM"},{"code":"72572042010","type":"NDC"}],"standard_charges":[{"gross_charge":93.65,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572042701","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"72572042701","type":"NDC"}],"standard_charges":[{"gross_charge":542.08,"discounted_cash":189.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572043001","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572043025","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043025","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx72572044001","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"72572044001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572044001","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"72572044001","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx72572044025","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"72572044025","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572045025","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"72572045025","type":"NDC"}],"standard_charges":[{"gross_charge":93.79,"discounted_cash":32.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572046101","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"72572046101","type":"NDC"}],"standard_charges":[{"gross_charge":99.28,"discounted_cash":34.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx72572048101","type":"CDM"},{"code":"72572048101","type":"NDC"}],"standard_charges":[{"gross_charge":97.51,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572052025","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72572052025","type":"NDC"}],"standard_charges":[{"gross_charge":93.93,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572058001","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"72572058001","type":"NDC"}],"standard_charges":[{"gross_charge":99.28,"discounted_cash":34.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572058025","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"72572058025","type":"NDC"}],"standard_charges":[{"gross_charge":99.28,"discounted_cash":34.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx72572074020","type":"CDM"},{"code":"72572074020","type":"NDC"}],"standard_charges":[{"gross_charge":96.4,"discounted_cash":33.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx72572074025","type":"CDM"},{"code":"72572074025","type":"NDC"}],"standard_charges":[{"gross_charge":96.4,"discounted_cash":33.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572074710","type":"CDM"},{"code":"72572074710","type":"NDC"}],"standard_charges":[{"gross_charge":94.37,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx72572075001","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"72572075001","type":"NDC"}],"standard_charges":[{"gross_charge":97.11,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx72572075010","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"72572075010","type":"NDC"}],"standard_charges":[{"gross_charge":97.11,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578003601","type":"CDM"},{"code":"72578003601","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ZONISAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578004001","type":"CDM"},{"code":"72578004001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578015001","type":"CDM"},{"code":"72578015001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72611072501","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72611072501","type":"NDC"}],"standard_charges":[{"gross_charge":93.41,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx72611074910","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72611074910","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx72611086001","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"72611086001","type":"NDC"}],"standard_charges":[{"gross_charge":383.04,"discounted_cash":134.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx72611086004","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"72611086004","type":"NDC"}],"standard_charges":[{"gross_charge":414.28,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888005301","type":"CDM"},{"code":"72888005301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888008001","type":"CDM"},{"code":"72888008001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx73293000102","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"73293000102","type":"NDC"}],"standard_charges":[{"gross_charge":93.52,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ULIPRISTAL ACETATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73302045601","type":"CDM"},{"code":"73302045601","type":"NDC"}],"standard_charges":[{"gross_charge":53.29,"discounted_cash":18.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx73702011503","type":"CDM"},{"code":"73702011503","type":"NDC"}],"standard_charges":[{"gross_charge":243.6,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx73702012510","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"73702012510","type":"NDC"}],"standard_charges":[{"gross_charge":93.64,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75826011410","type":"CDM"},{"code":"75826011410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75826011510","type":"CDM"},{"code":"75826011510","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHENOBARBITAL TAB 16.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75826013710","type":"CDM"},{"code":"75826013710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BALSAM PERU-CASTOR OIL OINT","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx75834013960","type":"CDM"},{"code":"75834013960","type":"NDC"}],"standard_charges":[{"gross_charge":26.01,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834015801","type":"CDM"},{"code":"75834015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834022101","type":"CDM"},{"code":"75834022101","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75907002348","type":"CDM"},{"code":"75907002348","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76014000333","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76014000333","type":"NDC"}],"standard_charges":[{"gross_charge":1573.6,"discounted_cash":550.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000410","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000410","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000411","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000901","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000901","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000906","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx76045000906","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000910","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000910","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000911","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045010120","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"76045010120","type":"NDC"}],"standard_charges":[{"gross_charge":94.13,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARFILZOMIB FOR INJ 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76075010101","type":"CDM"},{"code":"J9047","type":"HCPCS"},{"code":"76075010101","type":"NDC"}],"standard_charges":[{"gross_charge":36349.99,"discounted_cash":12722.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CARFILZOMIB FOR INJ 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76075010201","type":"CDM"},{"code":"J9047","type":"HCPCS"},{"code":"76075010201","type":"NDC"}],"standard_charges":[{"gross_charge":18226.32,"discounted_cash":6379.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx76125079025","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"76125079025","type":"NDC"}],"standard_charges":[{"gross_charge":380.8,"discounted_cash":133.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx76154047515","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"76154047515","type":"NDC"}],"standard_charges":[{"gross_charge":313.2,"discounted_cash":109.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76204001801","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"76204001801","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 3%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204002260","type":"CDM"},{"code":"J7131","type":"HCPCS"},{"code":"76204002260","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204030003","type":"CDM"},{"code":"76204030003","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204060001","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204070001","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204070001","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.31 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204070011","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204070011","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204080001","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204080011","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204080011","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090001","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090011","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090011","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76329124001","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"gross_charge":245.12,"discounted_cash":85.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76329124005","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"76329124005","type":"NDC"}],"standard_charges":[{"gross_charge":95.04,"discounted_cash":33.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 1 MG/ML,MORPHINE SULFATE IV SOLN PF 1 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx76329191101","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"76329191101","type":"NDC"}],"standard_charges":[{"gross_charge":157.89,"discounted_cash":55.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 1 MG/ML,MORPHINE SULFATE IV SOLN PF 1 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx76329191201","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"76329191201","type":"NDC"}],"standard_charges":[{"gross_charge":157.09,"discounted_cash":54.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329301305","type":"CDM"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329330401","type":"CDM"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":101.96,"discounted_cash":35.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76329331601","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"76329331601","type":"NDC"}],"standard_charges":[{"gross_charge":94.04,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76329331801","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":94.29,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx76329333901","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"76329333901","type":"NDC"}],"standard_charges":[{"gross_charge":96.43,"discounted_cash":33.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx76329334001","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"gross_charge":97.06,"discounted_cash":33.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329335201","type":"CDM"},{"code":"76329335201","type":"NDC"}],"standard_charges":[{"gross_charge":182.56,"discounted_cash":63.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx76329336901","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":97.09,"discounted_cash":33.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329339001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":99.9,"discounted_cash":34.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329339905","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"76329339905","type":"NDC"}],"standard_charges":[{"gross_charge":537.04,"discounted_cash":187.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76329906000","type":"CDM"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":94.37,"discounted_cash":33.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76329906100","type":"CDM"},{"code":"76329906100","type":"NDC"}],"standard_charges":[{"gross_charge":93.58,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76385010401","type":"CDM"},{"code":"76385010401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76385012301","type":"CDM"},{"code":"76385012301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76385013301","type":"CDM"},{"code":"76385013301","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76439013410","type":"CDM"},{"code":"76439013410","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB DISINT 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76439030710","type":"CDM"},{"code":"76439030710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76439030910","type":"CDM"},{"code":"76439030910","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011403","type":"CDM"},{"code":"78206011403","type":"NDC"}],"standard_charges":[{"gross_charge":53.29,"discounted_cash":18.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 110 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011501","type":"CDM"},{"code":"78206011501","type":"NDC"}],"standard_charges":[{"gross_charge":127.89,"discounted_cash":44.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206016201","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016201","type":"NDC"}],"standard_charges":[{"gross_charge":3966.48,"discounted_cash":1388.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"DANTROLENE SODIUM FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78670000367","type":"CDM"},{"code":"78670000367","type":"NDC"}],"standard_charges":[{"gross_charge":690.67,"discounted_cash":241.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx80830232901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"80830232901","type":"NDC"}],"standard_charges":[{"gross_charge":247.8,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"TRANEXAMIC ACID-SODIUM CHLORIDE IV SOLN 1000 MG/100ML-0.7%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx80830232903","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"80830232903","type":"NDC"}],"standard_charges":[{"gross_charge":246.4,"discounted_cash":86.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 2 GM/100ML-0.675% (20 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx80830236301","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"80830236301","type":"NDC"}],"standard_charges":[{"gross_charge":240.5,"discounted_cash":84.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx81033051250","type":"CDM"},{"code":"81033051250","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INDIGOTINDISULFONATE SODIUM IV SOLN 8 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81284031505","type":"CDM"},{"code":"J9220","type":"HCPCS"},{"code":"81284031505","type":"NDC"}],"standard_charges":[{"gross_charge":3491.54,"discounted_cash":1222.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81298866001","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"81298866001","type":"NDC"}],"standard_charges":[{"gross_charge":749.95,"discounted_cash":262.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81298866003","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"81298866003","type":"NDC"}],"standard_charges":[{"gross_charge":556.24,"discounted_cash":194.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"COCAINE HCL NASAL SOLN 40 MG/ML (4%)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx81665030102","type":"CDM"},{"code":"C9143","type":"HCPCS"},{"code":"81665030102","type":"NDC"}],"standard_charges":[{"gross_charge":457.48,"discounted_cash":160.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx81952012414","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"81952012414","type":"NDC"}],"standard_charges":[{"gross_charge":101.14,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx81952012424","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"81952012424","type":"NDC"}],"standard_charges":[{"gross_charge":101.14,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx82182010614","type":"CDM"},{"code":"82182010614","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347050505","type":"CDM"},{"code":"82347050505","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx83090000310","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"83090000310","type":"NDC"}],"standard_charges":[{"gross_charge":93.64,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx83090000710","type":"CDM"},{"code":"83090000710","type":"NDC"}],"standard_charges":[{"gross_charge":101.38,"discounted_cash":35.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"INSULIN GLARGINE-YFGN INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx83257001411","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"83257001411","type":"NDC"}],"standard_charges":[{"gross_charge":475.85,"discounted_cash":166.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx83634030202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"83634030202","type":"NDC"}],"standard_charges":[{"gross_charge":93.7,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx83634030242","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"83634030242","type":"NDC"}],"standard_charges":[{"gross_charge":94.8,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx83634030305","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"83634030305","type":"NDC"}],"standard_charges":[{"gross_charge":94.21,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx83634030342","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"83634030342","type":"NDC"}],"standard_charges":[{"gross_charge":94.31,"discounted_cash":33.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx83634050041","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"83634050041","type":"NDC"}],"standard_charges":[{"gross_charge":243.15,"discounted_cash":85.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx83634050081","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"83634050081","type":"NDC"}],"standard_charges":[{"gross_charge":243.15,"discounted_cash":85.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION"}]},{"description":"K-WIRE STYLE 7 - 1.1MM X 102MM","code_information":[{"code":"Sx00-0186-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725214","type":"LOCAL"},{"code":"736661","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.87,"discounted_cash":13.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 725214 = Hospital System Supply Identifier | 736661 = Lawson ID"}]},{"description":"K-WIRE STYLE 1 - 1.6MM X 229MM","code_information":[{"code":"Sx00-0186-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725212","type":"LOCAL"},{"code":"736659","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.87,"discounted_cash":13.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 725212 = Hospital System Supply Identifier | 736659 = Lawson ID"}]},{"description":"K-WIRE STYLE 7 - 1.6MM X 102MM","code_information":[{"code":"Sx00-0186-086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"725216","type":"LOCAL"},{"code":"736663","type":"LOCAL"}],"standard_charges":[{"gross_charge":37.87,"discounted_cash":13.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 725216 = Hospital System Supply Identifier | 736663 = Lawson ID"}]},{"description":"PLATE L1 ORTHOG BSSO LADR 39MM","code_information":[{"code":"Sx00-020-09-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779930","type":"LOCAL"},{"code":"773375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1412.92,"discounted_cash":494.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 779930 = Hospital System Supply Identifier | 773375 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36003","type":"LOCAL"},{"code":"245971","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 36003 = Hospital System Supply Identifier | 245971 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36002","type":"LOCAL"},{"code":"245970","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 36002 = Hospital System Supply Identifier | 245970 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 6IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36001","type":"LOCAL"},{"code":"245961","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 36001 = Hospital System Supply Identifier | 245961 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36000","type":"LOCAL"},{"code":"245960","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 36000 = Hospital System Supply Identifier | 245960 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35999","type":"LOCAL"},{"code":"245959","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35999 = Hospital System Supply Identifier | 245959 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35998","type":"LOCAL"},{"code":"245958","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35998 = Hospital System Supply Identifier | 245958 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35997","type":"LOCAL"},{"code":"245957","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35997 = Hospital System Supply Identifier | 245957 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35993","type":"LOCAL"},{"code":"245953","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35993 = Hospital System Supply Identifier | 245953 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35995","type":"LOCAL"},{"code":"245955","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35995 = Hospital System Supply Identifier | 245955 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35994","type":"LOCAL"},{"code":"245954","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35994 = Hospital System Supply Identifier | 245954 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35996","type":"LOCAL"},{"code":"245956","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35996 = Hospital System Supply Identifier | 245956 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35991","type":"LOCAL"},{"code":"245951","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35991 = Hospital System Supply Identifier | 245951 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35990","type":"LOCAL"},{"code":"245950","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35990 = Hospital System Supply Identifier | 245950 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35989","type":"LOCAL"},{"code":"245949","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35989 = Hospital System Supply Identifier | 245949 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"35992","type":"LOCAL"},{"code":"245952","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35992 = Hospital System Supply Identifier | 245952 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408069","type":"LOCAL"},{"code":"245946","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408069 = Hospital System Supply Identifier | 245946 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408068","type":"LOCAL"},{"code":"245945","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408068 = Hospital System Supply Identifier | 245945 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408067","type":"LOCAL"},{"code":"245944","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408067 = Hospital System Supply Identifier | 245944 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408066","type":"LOCAL"},{"code":"245943","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408066 = Hospital System Supply Identifier | 245943 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408065","type":"LOCAL"},{"code":"245942","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408065 = Hospital System Supply Identifier | 245942 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408064","type":"LOCAL"},{"code":"245941","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408064 = Hospital System Supply Identifier | 245941 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408057","type":"LOCAL"},{"code":"245920","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408057 = Hospital System Supply Identifier | 245920 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408061","type":"LOCAL"},{"code":"245927","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408061 = Hospital System Supply Identifier | 245927 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408058","type":"LOCAL"},{"code":"245922","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408058 = Hospital System Supply Identifier | 245922 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408070","type":"LOCAL"},{"code":"245947","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408070 = Hospital System Supply Identifier | 245947 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408072","type":"LOCAL"},{"code":"245969","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408072 = Hospital System Supply Identifier | 245969 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408060","type":"LOCAL"},{"code":"245926","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408060 = Hospital System Supply Identifier | 245926 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"408059","type":"LOCAL"},{"code":"245923","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408059 = Hospital System Supply Identifier | 245923 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408063","type":"LOCAL"},{"code":"245940","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408063 = Hospital System Supply Identifier | 245940 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 6IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408071","type":"LOCAL"},{"code":"245948","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":153.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408071 = Hospital System Supply Identifier | 245948 = Lawson ID"}]},{"description":"DISC - PIN STNMN 2.4MMX60CM","code_information":[{"code":"Sx00-0409-021","type":"CDM"},{"code":"272","type":"RC"},{"code":"410428","type":"LOCAL"},{"code":"417181","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410428 = Hospital System Supply Identifier | 417181 = Lawson ID"}]},{"description":"PIN STEINMANN 3.2X60","code_information":[{"code":"Sx00-0409-022","type":"CDM"},{"code":"272","type":"RC"},{"code":"411088","type":"LOCAL"},{"code":"437117","type":"LOCAL"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411088 = Hospital System Supply Identifier | 437117 = Lawson ID"}]},{"description":"PIN STNMN 4.0MMX60CM","code_information":[{"code":"Sx00-0409-023","type":"CDM"},{"code":"272","type":"RC"},{"code":"410429","type":"LOCAL"},{"code":"417182","type":"LOCAL"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410429 = Hospital System Supply Identifier | 417182 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM 6MM NSTRL BULLET TIP ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-034","type":"CDM"},{"code":"272","type":"RC"},{"code":"410441","type":"LOCAL"},{"code":"418220","type":"LOCAL"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410441 = Hospital System Supply Identifier | 418220 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-042","type":"CDM"},{"code":"272","type":"RC"},{"code":"409623","type":"LOCAL"},{"code":"402333","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409623 = Hospital System Supply Identifier | 402333 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-043","type":"CDM"},{"code":"272","type":"RC"},{"code":"409624","type":"LOCAL"},{"code":"402334","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409624 = Hospital System Supply Identifier | 402334 = Lawson ID"}]},{"description":"DISC - COLLAR CERV SERP MED XLNG 3.5","code_information":[{"code":"Sx00-0737-005","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"35006","type":"LOCAL"},{"code":"106778","type":"LOCAL"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":18.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35006 = Hospital System Supply Identifier | 106778 = Lawson ID"}]},{"description":"DUP USE S13371 - PIN RUSH MEDUL 1/4 801-01-03","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1173319","type":"LOCAL"},{"code":"245931","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":17.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1173319 = Hospital System Supply Identifier | 245931 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZI","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408056","type":"LOCAL"},{"code":"245915","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408056 = Hospital System Supply Identifier | 245915 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZH","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408055","type":"LOCAL"},{"code":"245914","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408055 = Hospital System Supply Identifier | 245914 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZG","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408054","type":"LOCAL"},{"code":"245913","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408054 = Hospital System Supply Identifier | 245913 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZF","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408053","type":"LOCAL"},{"code":"245912","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408053 = Hospital System Supply Identifier | 245912 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZD","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408051","type":"LOCAL"},{"code":"245910","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408051 = Hospital System Supply Identifier | 245910 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZC","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408050","type":"LOCAL"},{"code":"245909","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408050 = Hospital System Supply Identifier | 245909 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-1","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35272","type":"LOCAL"},{"code":"142730","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35272 = Hospital System Supply Identifier | 142730 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 28CMX6.4MM","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53562","type":"LOCAL"},{"code":"116024","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 53562 = Hospital System Supply Identifier | 116024 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-2","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35037","type":"LOCAL"},{"code":"116023","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35037 = Hospital System Supply Identifier | 116023 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZE","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408052","type":"LOCAL"},{"code":"245911","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408052 = Hospital System Supply Identifier | 245911 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-03","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407861","type":"LOCAL"},{"code":"206200","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407861 = Hospital System Supply Identifier | 206200 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY L 41.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408422","type":"LOCAL"},{"code":"328029","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408422 = Hospital System Supply Identifier | 328029 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-10","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407863","type":"LOCAL"},{"code":"206202","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407863 = Hospital System Supply Identifier | 206202 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-09","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407862","type":"LOCAL"},{"code":"206201","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407862 = Hospital System Supply Identifier | 206201 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-08","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407484","type":"LOCAL"},{"code":"147124","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407484 = Hospital System Supply Identifier | 147124 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 20.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53559","type":"LOCAL"},{"code":"116019","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 53559 = Hospital System Supply Identifier | 116019 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY D 26CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166633","type":"LOCAL"},{"code":"147122","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166633 = Hospital System Supply Identifier | 147122 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 3/16 802-01-06","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"55025","type":"LOCAL"},{"code":"142731","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 55025 = Hospital System Supply Identifier | 142731 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-04","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53560","type":"LOCAL"},{"code":"116020","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 53560 = Hospital System Supply Identifier | 116020 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-07","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166634","type":"LOCAL"},{"code":"147123","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166634 = Hospital System Supply Identifier | 147123 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-14","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168155","type":"LOCAL"},{"code":"206187","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168155 = Hospital System Supply Identifier | 206187 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-13","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168154","type":"LOCAL"},{"code":"206186","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168154 = Hospital System Supply Identifier | 206186 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 1/8 803-01-11","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168153","type":"LOCAL"},{"code":"206185","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168153 = Hospital System Supply Identifier | 206185 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-10","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168152","type":"LOCAL"},{"code":"206184","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168152 = Hospital System Supply Identifier | 206184 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-07","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168151","type":"LOCAL"},{"code":"206183","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168151 = Hospital System Supply Identifier | 206183 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-03","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168149","type":"LOCAL"},{"code":"206181","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168149 = Hospital System Supply Identifier | 206181 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-04","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168150","type":"LOCAL"},{"code":"206182","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168150 = Hospital System Supply Identifier | 206182 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-08","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166637","type":"LOCAL"},{"code":"147128","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166637 = Hospital System Supply Identifier | 147128 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-06","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166636","type":"LOCAL"},{"code":"147127","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166636 = Hospital System Supply Identifier | 147127 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-05","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407485","type":"LOCAL"},{"code":"147126","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407485 = Hospital System Supply Identifier | 147126 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-02","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166635","type":"LOCAL"},{"code":"147125","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166635 = Hospital System Supply Identifier | 147125 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-12","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53561","type":"LOCAL"},{"code":"116021","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 53561 = Hospital System Supply Identifier | 116021 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-09","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166638","type":"LOCAL"},{"code":"147129","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166638 = Hospital System Supply Identifier | 147129 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-10","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407856","type":"LOCAL"},{"code":"206195","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407856 = Hospital System Supply Identifier | 206195 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-14","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407860","type":"LOCAL"},{"code":"206199","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407860 = Hospital System Supply Identifier | 206199 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-13","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407859","type":"LOCAL"},{"code":"206198","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407859 = Hospital System Supply Identifier | 206198 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-12","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407858","type":"LOCAL"},{"code":"206197","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407858 = Hospital System Supply Identifier | 206197 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-11","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407857","type":"LOCAL"},{"code":"206196","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407857 = Hospital System Supply Identifier | 206196 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-09","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407855","type":"LOCAL"},{"code":"206194","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407855 = Hospital System Supply Identifier | 206194 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-02","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407486","type":"LOCAL"},{"code":"147130","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407486 = Hospital System Supply Identifier | 147130 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-07","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407853","type":"LOCAL"},{"code":"206192","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407853 = Hospital System Supply Identifier | 206192 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-06","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407852","type":"LOCAL"},{"code":"206191","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407852 = Hospital System Supply Identifier | 206191 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-05","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407851","type":"LOCAL"},{"code":"206190","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407851 = Hospital System Supply Identifier | 206190 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-04","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407850","type":"LOCAL"},{"code":"206189","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407850 = Hospital System Supply Identifier | 206189 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-03","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407849","type":"LOCAL"},{"code":"206188","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407849 = Hospital System Supply Identifier | 206188 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-08","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407854","type":"LOCAL"},{"code":"206193","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407854 = Hospital System Supply Identifier | 206193 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY U 20.3CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408758","type":"LOCAL"},{"code":"339790","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408758 = Hospital System Supply Identifier | 339790 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Y 25.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408762","type":"LOCAL"},{"code":"339794","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408762 = Hospital System Supply Identifier | 339794 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY X 24.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408761","type":"LOCAL"},{"code":"339793","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408761 = Hospital System Supply Identifier | 339793 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY W 22.9CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408760","type":"LOCAL"},{"code":"339792","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408760 = Hospital System Supply Identifier | 339792 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY V 21.6CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408759","type":"LOCAL"},{"code":"339791","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408759 = Hospital System Supply Identifier | 339791 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY T 19.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408757","type":"LOCAL"},{"code":"339789","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408757 = Hospital System Supply Identifier | 339789 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY R 16.5CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408755","type":"LOCAL"},{"code":"339787","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408755 = Hospital System Supply Identifier | 339787 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY S 17.8CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408756","type":"LOCAL"},{"code":"339788","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408756 = Hospital System Supply Identifier | 339788 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Q 15.2CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408754","type":"LOCAL"},{"code":"339786","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408754 = Hospital System Supply Identifier | 339786 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY P 14.0CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408753","type":"LOCAL"},{"code":"339785","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408753 = Hospital System Supply Identifier | 339785 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY O 12.7CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408752","type":"LOCAL"},{"code":"339784","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408752 = Hospital System Supply Identifier | 339784 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY N 11.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408751","type":"LOCAL"},{"code":"339783","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408751 = Hospital System Supply Identifier | 339783 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053825","type":"LOCAL"},{"code":"876275","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053825 = Hospital System Supply Identifier | 876275 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053826","type":"LOCAL"},{"code":"876276","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053826 = Hospital System Supply Identifier | 876276 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053827","type":"LOCAL"},{"code":"876277","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053827 = Hospital System Supply Identifier | 876277 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053830","type":"LOCAL"},{"code":"876280","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053830 = Hospital System Supply Identifier | 876280 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053828","type":"LOCAL"},{"code":"876278","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053828 = Hospital System Supply Identifier | 876278 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053829","type":"LOCAL"},{"code":"876279","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053829 = Hospital System Supply Identifier | 876279 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X12MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"918408","type":"LOCAL"},{"code":"711671","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 918408 = Hospital System Supply Identifier | 711671 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X14MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"832048","type":"LOCAL"},{"code":"711672","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 832048 = Hospital System Supply Identifier | 711672 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X16MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"832049","type":"LOCAL"},{"code":"711673","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 832049 = Hospital System Supply Identifier | 711673 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 10MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053831","type":"LOCAL"},{"code":"876281","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053831 = Hospital System Supply Identifier | 876281 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18 CORT NON LOK","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821235","type":"LOCAL"},{"code":"S121105","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821235 = Hospital System Supply Identifier | S121105 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 28MM","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053832","type":"LOCAL"},{"code":"876282","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053832 = Hospital System Supply Identifier | 876282 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932149","type":"LOCAL"},{"code":"816524","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932149 = Hospital System Supply Identifier | 816524 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944916","type":"LOCAL"},{"code":"829511","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944916 = Hospital System Supply Identifier | 829511 = Lawson ID"}]},{"description":"SCREW BONE 3.5X24CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932147","type":"LOCAL"},{"code":"816522","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932147 = Hospital System Supply Identifier | 816522 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932148","type":"LOCAL"},{"code":"816523","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932148 = Hospital System Supply Identifier | 816523 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932146","type":"LOCAL"},{"code":"816521","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932146 = Hospital System Supply Identifier | 816521 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932150","type":"LOCAL"},{"code":"816525","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932150 = Hospital System Supply Identifier | 816525 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 30MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053833","type":"LOCAL"},{"code":"876283","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053833 = Hospital System Supply Identifier | 876283 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053834","type":"LOCAL"},{"code":"876284","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053834 = Hospital System Supply Identifier | 876284 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MMS HEX 35MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053835","type":"LOCAL"},{"code":"876285","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053835 = Hospital System Supply Identifier | 876285 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053836","type":"LOCAL"},{"code":"876286","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053836 = Hospital System Supply Identifier | 876286 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 44MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053839","type":"LOCAL"},{"code":"876289","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053839 = Hospital System Supply Identifier | 876289 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 40MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053837","type":"LOCAL"},{"code":"876287","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053837 = Hospital System Supply Identifier | 876287 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053838","type":"LOCAL"},{"code":"876288","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053838 = Hospital System Supply Identifier | 876288 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX, 45MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053840","type":"LOCAL"},{"code":"876290","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053840 = Hospital System Supply Identifier | 876290 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053841","type":"LOCAL"},{"code":"876291","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053841 = Hospital System Supply Identifier | 876291 = Lawson ID"}]},{"description":"SCREW BONE 3.5X46 CORT NON-LOK","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821257","type":"LOCAL"},{"code":"S298652","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821257 = Hospital System Supply Identifier | S298652 = Lawson ID"}]},{"description":"SCREW BONE 3.5X50 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821258","type":"LOCAL"},{"code":"S48755","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821258 = Hospital System Supply Identifier | S48755 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 58MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053845","type":"LOCAL"},{"code":"876295","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053845 = Hospital System Supply Identifier | 876295 = Lawson ID"}]},{"description":"SCREW BONE 3.5X55 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821259","type":"LOCAL"},{"code":"S48756","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821259 = Hospital System Supply Identifier | S48756 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053843","type":"LOCAL"},{"code":"876293","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053843 = Hospital System Supply Identifier | 876293 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053842","type":"LOCAL"},{"code":"876292","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053842 = Hospital System Supply Identifier | 876292 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053844","type":"LOCAL"},{"code":"876294","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053844 = Hospital System Supply Identifier | 876294 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053847","type":"LOCAL"},{"code":"876297","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053847 = Hospital System Supply Identifier | 876297 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 60MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053846","type":"LOCAL"},{"code":"876296","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053846 = Hospital System Supply Identifier | 876296 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053848","type":"LOCAL"},{"code":"876298","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053848 = Hospital System Supply Identifier | 876298 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932142","type":"LOCAL"},{"code":"816517","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932142 = Hospital System Supply Identifier | 816517 = Lawson ID"}]},{"description":"SCREW BONE 3.5X16CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932144","type":"LOCAL"},{"code":"816519","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932144 = Hospital System Supply Identifier | 816519 = Lawson ID"}]},{"description":"SCREW BONE T15 103.5BLU NSTRL","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943269","type":"LOCAL"},{"code":"827838","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 943269 = Hospital System Supply Identifier | 827838 = Lawson ID"}]},{"description":"SCREW BONE 143.5NSTRL T15 HEXA","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943270","type":"LOCAL"},{"code":"827839","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 943270 = Hospital System Supply Identifier | 827839 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 12MM","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053849","type":"LOCAL"},{"code":"876299","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053849 = Hospital System Supply Identifier | 876299 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 24MM","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053850","type":"LOCAL"},{"code":"876300","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053850 = Hospital System Supply Identifier | 876300 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944914","type":"LOCAL"},{"code":"829509","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944914 = Hospital System Supply Identifier | 829509 = Lawson ID"}]},{"description":"SCREW BONE 3.5X28CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946351","type":"LOCAL"},{"code":"830987","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 946351 = Hospital System Supply Identifier | 830987 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932143","type":"LOCAL"},{"code":"816518","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932143 = Hospital System Supply Identifier | 816518 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932145","type":"LOCAL"},{"code":"816520","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932145 = Hospital System Supply Identifier | 816520 = Lawson ID"}]},{"description":"SCREW BONE 3.5X30CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944915","type":"LOCAL"},{"code":"829510","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944915 = Hospital System Supply Identifier | 829510 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944989","type":"LOCAL"},{"code":"829586","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944989 = Hospital System Supply Identifier | 829586 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946352","type":"LOCAL"},{"code":"830988","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 946352 = Hospital System Supply Identifier | 830988 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053851","type":"LOCAL"},{"code":"876301","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053851 = Hospital System Supply Identifier | 876301 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 35MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053852","type":"LOCAL"},{"code":"876302","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053852 = Hospital System Supply Identifier | 876302 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053853","type":"LOCAL"},{"code":"876303","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053853 = Hospital System Supply Identifier | 876303 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 46MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053856","type":"LOCAL"},{"code":"876306","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053856 = Hospital System Supply Identifier | 876306 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053857","type":"LOCAL"},{"code":"876307","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053857 = Hospital System Supply Identifier | 876307 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 45MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053855","type":"LOCAL"},{"code":"876305","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053855 = Hospital System Supply Identifier | 876305 = Lawson ID"}]},{"description":"SCREW BONE 3.5X44CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944991","type":"LOCAL"},{"code":"829588","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944991 = Hospital System Supply Identifier | 829588 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944990","type":"LOCAL"},{"code":"829587","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944990 = Hospital System Supply Identifier | 829587 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053854","type":"LOCAL"},{"code":"876304","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053854 = Hospital System Supply Identifier | 876304 = Lawson ID"}]},{"description":"SCREW BONE 3.5X50CORT LOCKING","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944992","type":"LOCAL"},{"code":"829589","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944992 = Hospital System Supply Identifier | 829589 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053858","type":"LOCAL"},{"code":"876308","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053858 = Hospital System Supply Identifier | 876308 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053859","type":"LOCAL"},{"code":"876309","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053859 = Hospital System Supply Identifier | 876309 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 50MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053860","type":"LOCAL"},{"code":"876310","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053860 = Hospital System Supply Identifier | 876310 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053861","type":"LOCAL"},{"code":"876311","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053861 = Hospital System Supply Identifier | 876311 = Lawson ID"}]},{"description":"SCREW BONE 3.5X60CORT LOCKING","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944993","type":"LOCAL"},{"code":"829590","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944993 = Hospital System Supply Identifier | 829590 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053862","type":"LOCAL"},{"code":"876312","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053862 = Hospital System Supply Identifier | 876312 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053863","type":"LOCAL"},{"code":"876313","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053863 = Hospital System Supply Identifier | 876313 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053867","type":"LOCAL"},{"code":"876317","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053867 = Hospital System Supply Identifier | 876317 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5LFT MEDIA","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932151","type":"LOCAL"},{"code":"816526","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932151 = Hospital System Supply Identifier | 816526 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053864","type":"LOCAL"},{"code":"876314","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053864 = Hospital System Supply Identifier | 876314 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053865","type":"LOCAL"},{"code":"876315","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053865 = Hospital System Supply Identifier | 876315 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053866","type":"LOCAL"},{"code":"876316","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053866 = Hospital System Supply Identifier | 876316 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053868","type":"LOCAL"},{"code":"876318","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053868 = Hospital System Supply Identifier | 876318 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053872","type":"LOCAL"},{"code":"876322","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053872 = Hospital System Supply Identifier | 876322 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053870","type":"LOCAL"},{"code":"876320","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053870 = Hospital System Supply Identifier | 876320 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053871","type":"LOCAL"},{"code":"876321","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053871 = Hospital System Supply Identifier | 876321 = Lawson ID"}]},{"description":"PLATE BONE NARROW 136NSTRL 8H","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943268","type":"LOCAL"},{"code":"827837","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 943268 = Hospital System Supply Identifier | 827837 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5RT MEDIAL","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932141","type":"LOCAL"},{"code":"816516","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932141 = Hospital System Supply Identifier | 816516 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053869","type":"LOCAL"},{"code":"876319","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053869 = Hospital System Supply Identifier | 876319 = Lawson ID"}]},{"description":"PLATE LT 4H 3.5WIDE MEDIAL DIS","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"946353","type":"LOCAL"},{"code":"830989","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 946353 = Hospital System Supply Identifier | 830989 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053873","type":"LOCAL"},{"code":"876323","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053873 = Hospital System Supply Identifier | 876323 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053874","type":"LOCAL"},{"code":"876324","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053874 = Hospital System Supply Identifier | 876324 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053875","type":"LOCAL"},{"code":"876325","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053875 = Hospital System Supply Identifier | 876325 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053876","type":"LOCAL"},{"code":"876326","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053876 = Hospital System Supply Identifier | 876326 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053877","type":"LOCAL"},{"code":"876327","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053877 = Hospital System Supply Identifier | 876327 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053883","type":"LOCAL"},{"code":"876333","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053883 = Hospital System Supply Identifier | 876333 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053882","type":"LOCAL"},{"code":"876332","type":"LOCAL"}],"standard_charges":[{"gross_charge":15335.87,"discounted_cash":5367.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053882 = Hospital System Supply Identifier | 876332 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053881","type":"LOCAL"},{"code":"876331","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053881 = Hospital System Supply Identifier | 876331 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053878","type":"LOCAL"},{"code":"876328","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053878 = Hospital System Supply Identifier | 876328 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 4H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053880","type":"LOCAL"},{"code":"876330","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053880 = Hospital System Supply Identifier | 876330 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053879","type":"LOCAL"},{"code":"876329","type":"LOCAL"}],"standard_charges":[{"gross_charge":10307.06,"discounted_cash":3607.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053879 = Hospital System Supply Identifier | 876329 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053884","type":"LOCAL"},{"code":"876334","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053884 = Hospital System Supply Identifier | 876334 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053885","type":"LOCAL"},{"code":"876335","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053885 = Hospital System Supply Identifier | 876335 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053886","type":"LOCAL"},{"code":"876336","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053886 = Hospital System Supply Identifier | 876336 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053887","type":"LOCAL"},{"code":"876337","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053887 = Hospital System Supply Identifier | 876337 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053888","type":"LOCAL"},{"code":"876338","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053888 = Hospital System Supply Identifier | 876338 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053893","type":"LOCAL"},{"code":"876343","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053893 = Hospital System Supply Identifier | 876343 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053892","type":"LOCAL"},{"code":"876342","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053892 = Hospital System Supply Identifier | 876342 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053890","type":"LOCAL"},{"code":"876340","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053890 = Hospital System Supply Identifier | 876340 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053889","type":"LOCAL"},{"code":"876339","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053889 = Hospital System Supply Identifier | 876339 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053891","type":"LOCAL"},{"code":"876341","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053891 = Hospital System Supply Identifier | 876341 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053894","type":"LOCAL"},{"code":"876344","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053894 = Hospital System Supply Identifier | 876344 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053895","type":"LOCAL"},{"code":"876345","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053895 = Hospital System Supply Identifier | 876345 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053896","type":"LOCAL"},{"code":"876346","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053896 = Hospital System Supply Identifier | 876346 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053897","type":"LOCAL"},{"code":"876347","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053897 = Hospital System Supply Identifier | 876347 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053898","type":"LOCAL"},{"code":"876348","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053898 = Hospital System Supply Identifier | 876348 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 10MM","code_information":[{"code":"Sx00-0903-387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053899","type":"LOCAL"},{"code":"876349","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053899 = Hospital System Supply Identifier | 876349 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053904","type":"LOCAL"},{"code":"876354","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053904 = Hospital System Supply Identifier | 876354 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053903","type":"LOCAL"},{"code":"876353","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053903 = Hospital System Supply Identifier | 876353 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053901","type":"LOCAL"},{"code":"876351","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053901 = Hospital System Supply Identifier | 876351 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053900","type":"LOCAL"},{"code":"876350","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053900 = Hospital System Supply Identifier | 876350 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053902","type":"LOCAL"},{"code":"876352","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053902 = Hospital System Supply Identifier | 876352 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053905","type":"LOCAL"},{"code":"876355","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053905 = Hospital System Supply Identifier | 876355 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053906","type":"LOCAL"},{"code":"876356","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053906 = Hospital System Supply Identifier | 876356 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053907","type":"LOCAL"},{"code":"876357","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053907 = Hospital System Supply Identifier | 876357 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053908","type":"LOCAL"},{"code":"876358","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053908 = Hospital System Supply Identifier | 876358 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053909","type":"LOCAL"},{"code":"876359","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053909 = Hospital System Supply Identifier | 876359 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053914","type":"LOCAL"},{"code":"876364","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053914 = Hospital System Supply Identifier | 876364 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053913","type":"LOCAL"},{"code":"876363","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053913 = Hospital System Supply Identifier | 876363 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053910","type":"LOCAL"},{"code":"876360","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053910 = Hospital System Supply Identifier | 876360 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053911","type":"LOCAL"},{"code":"876361","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053911 = Hospital System Supply Identifier | 876361 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053912","type":"LOCAL"},{"code":"876362","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053912 = Hospital System Supply Identifier | 876362 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 15MM","code_information":[{"code":"Sx00-0903-397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053915","type":"LOCAL"},{"code":"876365","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.0,"discounted_cash":1627.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053915 = Hospital System Supply Identifier | 876365 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036103 3.5MM","code_information":[{"code":"Sx00-0903-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356466","type":"LOCAL"},{"code":"1082536","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356466 = Hospital System Supply Identifier | 1082536 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036203 3.5MM","code_information":[{"code":"Sx00-0903-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356350","type":"LOCAL"},{"code":"1082496","type":"LOCAL"}],"standard_charges":[{"gross_charge":11152.65,"discounted_cash":3903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356350 = Hospital System Supply Identifier | 1082496 = Lawson ID"}]},{"description":"PLATE INF 90D 3HL","code_information":[{"code":"Sx00-0907-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053916","type":"LOCAL"},{"code":"876366","type":"LOCAL"}],"standard_charges":[{"gross_charge":9680.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053916 = Hospital System Supply Identifier | 876366 = Lawson ID"}]},{"description":"PLATE INF 110D 3HL","code_information":[{"code":"Sx00-0907-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053917","type":"LOCAL"},{"code":"876367","type":"LOCAL"}],"standard_charges":[{"gross_charge":9680.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053917 = Hospital System Supply Identifier | 876367 = Lawson ID"}]},{"description":"PLATE INF 130D 3HL","code_information":[{"code":"Sx00-0907-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053918","type":"LOCAL"},{"code":"876368","type":"LOCAL"}],"standard_charges":[{"gross_charge":9680.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053918 = Hospital System Supply Identifier | 876368 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053919","type":"LOCAL"},{"code":"876369","type":"LOCAL"}],"standard_charges":[{"gross_charge":9568.02,"discounted_cash":3348.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053919 = Hospital System Supply Identifier | 876369 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053920","type":"LOCAL"},{"code":"876370","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053920 = Hospital System Supply Identifier | 876370 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 6OFFSET","code_information":[{"code":"Sx00-0907-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944994","type":"LOCAL"},{"code":"829591","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944994 = Hospital System Supply Identifier | 829591 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053921","type":"LOCAL"},{"code":"876371","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053921 = Hospital System Supply Identifier | 876371 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053922","type":"LOCAL"},{"code":"876372","type":"LOCAL"}],"standard_charges":[{"gross_charge":9872.94,"discounted_cash":3455.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053922 = Hospital System Supply Identifier | 876372 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053923","type":"LOCAL"},{"code":"876373","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053923 = Hospital System Supply Identifier | 876373 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 12OFFSET","code_information":[{"code":"Sx00-0907-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944995","type":"LOCAL"},{"code":"829592","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944995 = Hospital System Supply Identifier | 829592 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053924","type":"LOCAL"},{"code":"876374","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053924 = Hospital System Supply Identifier | 876374 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053925","type":"LOCAL"},{"code":"876375","type":"LOCAL"}],"standard_charges":[{"gross_charge":9789.78,"discounted_cash":3426.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053925 = Hospital System Supply Identifier | 876375 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053926","type":"LOCAL"},{"code":"876376","type":"LOCAL"}],"standard_charges":[{"gross_charge":9789.78,"discounted_cash":3426.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053926 = Hospital System Supply Identifier | 876376 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053927","type":"LOCAL"},{"code":"876377","type":"LOCAL"}],"standard_charges":[{"gross_charge":10212.93,"discounted_cash":3574.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053927 = Hospital System Supply Identifier | 876377 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053928","type":"LOCAL"},{"code":"876378","type":"LOCAL"}],"standard_charges":[{"gross_charge":10212.93,"discounted_cash":3574.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053928 = Hospital System Supply Identifier | 876378 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053929","type":"LOCAL"},{"code":"876379","type":"LOCAL"}],"standard_charges":[{"gross_charge":10212.93,"discounted_cash":3574.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053929 = Hospital System Supply Identifier | 876379 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 3HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053930","type":"LOCAL"},{"code":"876380","type":"LOCAL"}],"standard_charges":[{"gross_charge":9948.01,"discounted_cash":3481.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053930 = Hospital System Supply Identifier | 876380 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053931","type":"LOCAL"},{"code":"876381","type":"LOCAL"}],"standard_charges":[{"gross_charge":9948.01,"discounted_cash":3481.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053931 = Hospital System Supply Identifier | 876381 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053932","type":"LOCAL"},{"code":"876382","type":"LOCAL"}],"standard_charges":[{"gross_charge":10212.93,"discounted_cash":3574.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053932 = Hospital System Supply Identifier | 876382 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053933","type":"LOCAL"},{"code":"876383","type":"LOCAL"}],"standard_charges":[{"gross_charge":10212.93,"discounted_cash":3574.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053933 = Hospital System Supply Identifier | 876383 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053934","type":"LOCAL"},{"code":"876384","type":"LOCAL"}],"standard_charges":[{"gross_charge":10212.93,"discounted_cash":3574.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053934 = Hospital System Supply Identifier | 876384 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 8HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053936","type":"LOCAL"},{"code":"876386","type":"LOCAL"}],"standard_charges":[{"gross_charge":15413.47,"discounted_cash":5394.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053936 = Hospital System Supply Identifier | 876386 = Lawson ID"}]},{"description":"PLATE BONE 3.5 130-DEG 6-HOLE","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"818909","type":"LOCAL"},{"code":"S48754","type":"LOCAL"}],"standard_charges":[{"gross_charge":10817.94,"discounted_cash":3786.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 818909 = Hospital System Supply Identifier | S48754 = Lawson ID"}]},{"description":"PLATE BONE 130 DEG 784H SS","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945776","type":"LOCAL"},{"code":"830396","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 945776 = Hospital System Supply Identifier | 830396 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053935","type":"LOCAL"},{"code":"876385","type":"LOCAL"}],"standard_charges":[{"gross_charge":10349.95,"discounted_cash":3622.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053935 = Hospital System Supply Identifier | 876385 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 10HL","code_information":[{"code":"Sx00-0907-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053937","type":"LOCAL"},{"code":"876387","type":"LOCAL"}],"standard_charges":[{"gross_charge":15413.47,"discounted_cash":5394.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053937 = Hospital System Supply Identifier | 876387 = Lawson ID"}]},{"description":"PLATE BONE 130 D FEM PROX 8H L","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939584","type":"LOCAL"},{"code":"824109","type":"LOCAL"}],"standard_charges":[{"gross_charge":15413.47,"discounted_cash":5394.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939584 = Hospital System Supply Identifier | 824109 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 3HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053938","type":"LOCAL"},{"code":"876388","type":"LOCAL"}],"standard_charges":[{"gross_charge":9789.78,"discounted_cash":3426.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053938 = Hospital System Supply Identifier | 876388 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 6HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053939","type":"LOCAL"},{"code":"876389","type":"LOCAL"}],"standard_charges":[{"gross_charge":10212.93,"discounted_cash":3574.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053939 = Hospital System Supply Identifier | 876389 = Lawson ID"}]},{"description":"PLATE BONE FX 4.5 130-DEG 4-HO","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"819260","type":"LOCAL"},{"code":"S298651","type":"LOCAL"}],"standard_charges":[{"gross_charge":9948.01,"discounted_cash":3481.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 819260 = Hospital System Supply Identifier | S298651 = Lawson ID"}]},{"description":"PLATE 103DX4.5MM 10HL","code_information":[{"code":"Sx00-0907-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053940","type":"LOCAL"},{"code":"876390","type":"LOCAL"}],"standard_charges":[{"gross_charge":15413.47,"discounted_cash":5394.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053940 = Hospital System Supply Identifier | 876390 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053941","type":"LOCAL"},{"code":"876391","type":"LOCAL"}],"standard_charges":[{"gross_charge":10349.95,"discounted_cash":3622.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053941 = Hospital System Supply Identifier | 876391 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 5HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053942","type":"LOCAL"},{"code":"876392","type":"LOCAL"}],"standard_charges":[{"gross_charge":10646.84,"discounted_cash":3726.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053942 = Hospital System Supply Identifier | 876392 = Lawson ID"}]},{"description":"PLATE 150DX4.5 3HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053943","type":"LOCAL"},{"code":"876393","type":"LOCAL"}],"standard_charges":[{"gross_charge":9517.2,"discounted_cash":3331.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053943 = Hospital System Supply Identifier | 876393 = Lawson ID"}]},{"description":"PLATE 150DX4.5 5HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053944","type":"LOCAL"},{"code":"876394","type":"LOCAL"}],"standard_charges":[{"gross_charge":9789.78,"discounted_cash":3426.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053944 = Hospital System Supply Identifier | 876394 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X38MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053948","type":"LOCAL"},{"code":"876398","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053948 = Hospital System Supply Identifier | 876398 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X32MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053946","type":"LOCAL"},{"code":"876396","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053946 = Hospital System Supply Identifier | 876396 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X34MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053947","type":"LOCAL"},{"code":"876397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053947 = Hospital System Supply Identifier | 876397 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X30MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053945","type":"LOCAL"},{"code":"876395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053945 = Hospital System Supply Identifier | 876395 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CANN LOCKING","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945774","type":"LOCAL"},{"code":"830394","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 945774 = Hospital System Supply Identifier | 830394 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CANN LOCKING","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"945775","type":"LOCAL"},{"code":"830395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 945775 = Hospital System Supply Identifier | 830395 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X45MM","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053949","type":"LOCAL"},{"code":"876399","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053949 = Hospital System Supply Identifier | 876399 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X50MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053950","type":"LOCAL"},{"code":"876400","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053950 = Hospital System Supply Identifier | 876400 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X55MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053951","type":"LOCAL"},{"code":"876401","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053951 = Hospital System Supply Identifier | 876401 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X60MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053952","type":"LOCAL"},{"code":"876402","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053952 = Hospital System Supply Identifier | 876402 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X65MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053953","type":"LOCAL"},{"code":"876403","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053953 = Hospital System Supply Identifier | 876403 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X70MM","code_information":[{"code":"Sx00-0907-377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053954","type":"LOCAL"},{"code":"876404","type":"LOCAL"}],"standard_charges":[{"gross_charge":2821.43,"discounted_cash":987.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053954 = Hospital System Supply Identifier | 876404 = Lawson ID"}]},{"description":"PLATE 140DX3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053955","type":"LOCAL"},{"code":"876405","type":"LOCAL"}],"standard_charges":[{"gross_charge":11025.2,"discounted_cash":3858.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053955 = Hospital System Supply Identifier | 876405 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074103 3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356942","type":"LOCAL"},{"code":"1082505","type":"LOCAL"}],"standard_charges":[{"gross_charge":10518.3,"discounted_cash":3681.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356942 = Hospital System Supply Identifier | 1082505 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074203 4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356944","type":"LOCAL"},{"code":"1082555","type":"LOCAL"}],"standard_charges":[{"gross_charge":10518.3,"discounted_cash":3681.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356944 = Hospital System Supply Identifier | 1082555 = Lawson ID"}]},{"description":"PLATE 140DX4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053956","type":"LOCAL"},{"code":"876406","type":"LOCAL"}],"standard_charges":[{"gross_charge":10422.6,"discounted_cash":3647.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053956 = Hospital System Supply Identifier | 876406 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X10MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053957","type":"LOCAL"},{"code":"876407","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053957 = Hospital System Supply Identifier | 876407 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X12MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053958","type":"LOCAL"},{"code":"876408","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053958 = Hospital System Supply Identifier | 876408 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X14MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053959","type":"LOCAL"},{"code":"876409","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053959 = Hospital System Supply Identifier | 876409 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X16MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053960","type":"LOCAL"},{"code":"876410","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053960 = Hospital System Supply Identifier | 876410 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X18MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053961","type":"LOCAL"},{"code":"876411","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053961 = Hospital System Supply Identifier | 876411 = Lawson ID"}]},{"description":"SCREW BONE 4.5X20 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821595","type":"LOCAL"},{"code":"S298654","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821595 = Hospital System Supply Identifier | S298654 = Lawson ID"}]},{"description":"SCREW BONE 4.5X22 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821596","type":"LOCAL"},{"code":"S298653","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821596 = Hospital System Supply Identifier | S298653 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X28MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053963","type":"LOCAL"},{"code":"876413","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053963 = Hospital System Supply Identifier | 876413 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X26MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053962","type":"LOCAL"},{"code":"876412","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053962 = Hospital System Supply Identifier | 876412 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 SLF-TP CORT","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971157","type":"LOCAL"},{"code":"841869","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971157 = Hospital System Supply Identifier | 841869 = Lawson ID"}]},{"description":"SCREW BONE 384.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939587","type":"LOCAL"},{"code":"824112","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939587 = Hospital System Supply Identifier | 824112 = Lawson ID"}]},{"description":"SCREW BONE 364.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939588","type":"LOCAL"},{"code":"824113","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939588 = Hospital System Supply Identifier | 824113 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X30MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053964","type":"LOCAL"},{"code":"876414","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053964 = Hospital System Supply Identifier | 876414 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X32MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053965","type":"LOCAL"},{"code":"876415","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053965 = Hospital System Supply Identifier | 876415 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X34MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053966","type":"LOCAL"},{"code":"876416","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053966 = Hospital System Supply Identifier | 876416 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X48MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053971","type":"LOCAL"},{"code":"876421","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053971 = Hospital System Supply Identifier | 876421 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X44MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053969","type":"LOCAL"},{"code":"876419","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053969 = Hospital System Supply Identifier | 876419 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X46MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053970","type":"LOCAL"},{"code":"876420","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053970 = Hospital System Supply Identifier | 876420 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X40MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053967","type":"LOCAL"},{"code":"876417","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053967 = Hospital System Supply Identifier | 876417 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X42MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053968","type":"LOCAL"},{"code":"876418","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053968 = Hospital System Supply Identifier | 876418 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X50MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053972","type":"LOCAL"},{"code":"876422","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053972 = Hospital System Supply Identifier | 876422 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X55MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053973","type":"LOCAL"},{"code":"876423","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053973 = Hospital System Supply Identifier | 876423 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X60MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053974","type":"LOCAL"},{"code":"876424","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053974 = Hospital System Supply Identifier | 876424 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X65MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053975","type":"LOCAL"},{"code":"876425","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053975 = Hospital System Supply Identifier | 876425 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X70MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053976","type":"LOCAL"},{"code":"876426","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053976 = Hospital System Supply Identifier | 876426 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X75MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053977","type":"LOCAL"},{"code":"876427","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053977 = Hospital System Supply Identifier | 876427 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X80MM","code_information":[{"code":"Sx00-0907-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053978","type":"LOCAL"},{"code":"876428","type":"LOCAL"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053978 = Hospital System Supply Identifier | 876428 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X18","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053983","type":"LOCAL"},{"code":"876433","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053983 = Hospital System Supply Identifier | 876433 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X16","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053982","type":"LOCAL"},{"code":"876432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053982 = Hospital System Supply Identifier | 876432 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X12","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053980","type":"LOCAL"},{"code":"876430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053980 = Hospital System Supply Identifier | 876430 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X14","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053981","type":"LOCAL"},{"code":"876431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053981 = Hospital System Supply Identifier | 876431 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X10","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053979","type":"LOCAL"},{"code":"876429","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053979 = Hospital System Supply Identifier | 876429 = Lawson ID"}]},{"description":"SCREW BONE 20X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971155","type":"LOCAL"},{"code":"841867","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971155 = Hospital System Supply Identifier | 841867 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971156","type":"LOCAL"},{"code":"841868","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971156 = Hospital System Supply Identifier | 841868 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X22","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053984","type":"LOCAL"},{"code":"876434","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053984 = Hospital System Supply Identifier | 876434 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X26","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053985","type":"LOCAL"},{"code":"876435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053985 = Hospital System Supply Identifier | 876435 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X28","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053986","type":"LOCAL"},{"code":"876436","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053986 = Hospital System Supply Identifier | 876436 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X38","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053991","type":"LOCAL"},{"code":"876441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053991 = Hospital System Supply Identifier | 876441 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X36","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053990","type":"LOCAL"},{"code":"876440","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053990 = Hospital System Supply Identifier | 876440 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X34","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053989","type":"LOCAL"},{"code":"876439","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053989 = Hospital System Supply Identifier | 876439 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X32","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053988","type":"LOCAL"},{"code":"876438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053988 = Hospital System Supply Identifier | 876438 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X30","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053987","type":"LOCAL"},{"code":"876437","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053987 = Hospital System Supply Identifier | 876437 = Lawson ID"}]},{"description":"SCREW BONE 42X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971158","type":"LOCAL"},{"code":"841870","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971158 = Hospital System Supply Identifier | 841870 = Lawson ID"}]},{"description":"SCREW BONE 46X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971159","type":"LOCAL"},{"code":"841871","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971159 = Hospital System Supply Identifier | 841871 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X40","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053992","type":"LOCAL"},{"code":"876442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053992 = Hospital System Supply Identifier | 876442 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X44","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053993","type":"LOCAL"},{"code":"876443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053993 = Hospital System Supply Identifier | 876443 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X45","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053994","type":"LOCAL"},{"code":"876444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053994 = Hospital System Supply Identifier | 876444 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X48","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053995","type":"LOCAL"},{"code":"876445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053995 = Hospital System Supply Identifier | 876445 = Lawson ID"}]},{"description":"SCREW BONE 55X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971161","type":"LOCAL"},{"code":"841873","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971161 = Hospital System Supply Identifier | 841873 = Lawson ID"}]},{"description":"SCREW BONE 50X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971160","type":"LOCAL"},{"code":"841872","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971160 = Hospital System Supply Identifier | 841872 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X60","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053996","type":"LOCAL"},{"code":"876446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053996 = Hospital System Supply Identifier | 876446 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X65","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053997","type":"LOCAL"},{"code":"876447","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053997 = Hospital System Supply Identifier | 876447 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X70","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053998","type":"LOCAL"},{"code":"876448","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053998 = Hospital System Supply Identifier | 876448 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X75","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1053999","type":"LOCAL"},{"code":"876449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1053999 = Hospital System Supply Identifier | 876449 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X80","code_information":[{"code":"Sx00-0907-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054000","type":"LOCAL"},{"code":"876450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.36,"discounted_cash":496.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054000 = Hospital System Supply Identifier | 876450 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X38MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054005","type":"LOCAL"},{"code":"876455","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054005 = Hospital System Supply Identifier | 876455 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X34MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054003","type":"LOCAL"},{"code":"876453","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054003 = Hospital System Supply Identifier | 876453 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X36MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054004","type":"LOCAL"},{"code":"876454","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054004 = Hospital System Supply Identifier | 876454 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X30MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054001","type":"LOCAL"},{"code":"876451","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054001 = Hospital System Supply Identifier | 876451 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X32MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054002","type":"LOCAL"},{"code":"876452","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054002 = Hospital System Supply Identifier | 876452 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X40MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054006","type":"LOCAL"},{"code":"876456","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054006 = Hospital System Supply Identifier | 876456 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X45MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054007","type":"LOCAL"},{"code":"876457","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054007 = Hospital System Supply Identifier | 876457 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X50MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054008","type":"LOCAL"},{"code":"876458","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054008 = Hospital System Supply Identifier | 876458 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X55MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054009","type":"LOCAL"},{"code":"876459","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054009 = Hospital System Supply Identifier | 876459 = Lawson ID"}]},{"description":"SCREW BONE 654.5PROX FEM T20 H","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939586","type":"LOCAL"},{"code":"824111","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939586 = Hospital System Supply Identifier | 824111 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X60MM","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054010","type":"LOCAL"},{"code":"876460","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054010 = Hospital System Supply Identifier | 876460 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X70MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054011","type":"LOCAL"},{"code":"876461","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054011 = Hospital System Supply Identifier | 876461 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X75MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054012","type":"LOCAL"},{"code":"876462","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054012 = Hospital System Supply Identifier | 876462 = Lawson ID"}]},{"description":"SCREW BONE 804.5HEXALOBE FEM P","code_information":[{"code":"Sx00-0907-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939585","type":"LOCAL"},{"code":"824110","type":"LOCAL"}],"standard_charges":[{"gross_charge":2632.58,"discounted_cash":921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939585 = Hospital System Supply Identifier | 824110 = Lawson ID"}]},{"description":"DISC - GWIRE RM MDLLRY4.7X68","code_information":[{"code":"Sx00-0928-039","type":"CDM"},{"code":"272","type":"RC"},{"code":"408388","type":"LOCAL"},{"code":"310986","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408388 = Hospital System Supply Identifier | 310986 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-100-63-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779931","type":"LOCAL"},{"code":"773376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1969.06,"discounted_cash":689.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 779931 = Hospital System Supply Identifier | 773376 = Lawson ID"}]},{"description":"NAIL FLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054013","type":"LOCAL"},{"code":"876463","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054013 = Hospital System Supply Identifier | 876463 = Lawson ID"}]},{"description":"NAIL FLEX TI 2.0MM","code_information":[{"code":"Sx00-1000-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054014","type":"LOCAL"},{"code":"876464","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054014 = Hospital System Supply Identifier | 876464 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 2.5TI FLEX","code_information":[{"code":"Sx00-1000-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"932137","type":"LOCAL"},{"code":"816512","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 932137 = Hospital System Supply Identifier | 816512 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.0MM","code_information":[{"code":"Sx00-1000-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054015","type":"LOCAL"},{"code":"876465","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054015 = Hospital System Supply Identifier | 876465 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054016","type":"LOCAL"},{"code":"876466","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054016 = Hospital System Supply Identifier | 876466 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.0MM","code_information":[{"code":"Sx00-1000-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054017","type":"LOCAL"},{"code":"876467","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054017 = Hospital System Supply Identifier | 876467 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054018","type":"LOCAL"},{"code":"876468","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054018 = Hospital System Supply Identifier | 876468 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2MM","code_information":[{"code":"Sx00-1000-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881051","type":"LOCAL"},{"code":"401794","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.69,"discounted_cash":363.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 881051 = Hospital System Supply Identifier | 401794 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2.5MM","code_information":[{"code":"Sx00-1000-125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881052","type":"LOCAL"},{"code":"401795","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.69,"discounted_cash":363.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 881052 = Hospital System Supply Identifier | 401795 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3MM","code_information":[{"code":"Sx00-1000-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881053","type":"LOCAL"},{"code":"401796","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.69,"discounted_cash":363.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 881053 = Hospital System Supply Identifier | 401796 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3.5MM","code_information":[{"code":"Sx00-1000-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050783","type":"LOCAL"},{"code":"401797","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.69,"discounted_cash":363.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050783 = Hospital System Supply Identifier | 401797 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4MM","code_information":[{"code":"Sx00-1000-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050784","type":"LOCAL"},{"code":"401798","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.69,"discounted_cash":363.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050784 = Hospital System Supply Identifier | 401798 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4.5MM","code_information":[{"code":"Sx00-1000-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050785","type":"LOCAL"},{"code":"401799","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.69,"discounted_cash":363.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050785 = Hospital System Supply Identifier | 401799 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 1.5MM","code_information":[{"code":"Sx00-1000-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"817980","type":"LOCAL"},{"code":"S281845","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 817980 = Hospital System Supply Identifier | S281845 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2MM","code_information":[{"code":"Sx00-1000-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050786","type":"LOCAL"},{"code":"401801","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050786 = Hospital System Supply Identifier | 401801 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5MM","code_information":[{"code":"Sx00-1000-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"817981","type":"LOCAL"},{"code":"S281846","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 817981 = Hospital System Supply Identifier | S281846 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3MM","code_information":[{"code":"Sx00-1000-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050787","type":"LOCAL"},{"code":"401803","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050787 = Hospital System Supply Identifier | 401803 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5MM","code_information":[{"code":"Sx00-1000-335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050788","type":"LOCAL"},{"code":"401804","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050788 = Hospital System Supply Identifier | 401804 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4MM","code_information":[{"code":"Sx00-1000-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050789","type":"LOCAL"},{"code":"401805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050789 = Hospital System Supply Identifier | 401805 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881047","type":"LOCAL"},{"code":"401787","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 881047 = Hospital System Supply Identifier | 401787 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2MM","code_information":[{"code":"Sx00-1000-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881048","type":"LOCAL"},{"code":"401788","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 881048 = Hospital System Supply Identifier | 401788 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2.5MM","code_information":[{"code":"Sx00-1000-525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881049","type":"LOCAL"},{"code":"401789","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 881049 = Hospital System Supply Identifier | 401789 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3MM","code_information":[{"code":"Sx00-1000-530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"881050","type":"LOCAL"},{"code":"401790","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 881050 = Hospital System Supply Identifier | 401790 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050780","type":"LOCAL"},{"code":"401791","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050780 = Hospital System Supply Identifier | 401791 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4MM","code_information":[{"code":"Sx00-1000-540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050781","type":"LOCAL"},{"code":"401792","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050781 = Hospital System Supply Identifier | 401792 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050782","type":"LOCAL"},{"code":"401793","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050782 = Hospital System Supply Identifier | 401793 = Lawson ID"}]},{"description":"NAIL FLEX SS RND TIP 1.5X300MM","code_information":[{"code":"Sx00-1000-615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886407","type":"LOCAL"},{"code":"454543","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 886407 = Hospital System Supply Identifier | 454543 = Lawson ID"}]},{"description":"NAIL PEDIFLEX RND TIP SS 2.0MM","code_information":[{"code":"Sx00-1000-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886242","type":"LOCAL"},{"code":"449446","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 886242 = Hospital System Supply Identifier | 449446 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5X300MM","code_information":[{"code":"Sx00-1000-625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"886717","type":"LOCAL"},{"code":"455417","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 886717 = Hospital System Supply Identifier | 455417 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.0X400MM","code_information":[{"code":"Sx00-1000-630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051021","type":"LOCAL"},{"code":"455418","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1051021 = Hospital System Supply Identifier | 455418 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5X400MM","code_information":[{"code":"Sx00-1000-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051022","type":"LOCAL"},{"code":"455419","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1051022 = Hospital System Supply Identifier | 455419 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4.0X450MM","code_information":[{"code":"Sx00-1000-640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051023","type":"LOCAL"},{"code":"455420","type":"LOCAL"}],"standard_charges":[{"gross_charge":2508.37,"discounted_cash":877.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1051023 = Hospital System Supply Identifier | 455420 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 1.5X300","code_information":[{"code":"Sx00-1001-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054019","type":"LOCAL"},{"code":"876469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054019 = Hospital System Supply Identifier | 876469 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.0X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054020","type":"LOCAL"},{"code":"876470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054020 = Hospital System Supply Identifier | 876470 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.5X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054021","type":"LOCAL"},{"code":"876471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054021 = Hospital System Supply Identifier | 876471 = Lawson ID"}]},{"description":"NAIL TI 3.0MMX400FLEX","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942921","type":"LOCAL"},{"code":"827479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 942921 = Hospital System Supply Identifier | 827479 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 3.5X400","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054022","type":"LOCAL"},{"code":"876472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054022 = Hospital System Supply Identifier | 876472 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 4.0X450","code_information":[{"code":"Sx00-1001-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054023","type":"LOCAL"},{"code":"876473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054023 = Hospital System Supply Identifier | 876473 = Lawson ID"}]},{"description":"NAIL TI FLEX 1.5MMX300MM","code_information":[{"code":"Sx00-1001-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"943005","type":"LOCAL"},{"code":"827565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 943005 = Hospital System Supply Identifier | 827565 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.5MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942911","type":"LOCAL"},{"code":"827469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 942911 = Hospital System Supply Identifier | 827469 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.0MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942912","type":"LOCAL"},{"code":"827470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 942912 = Hospital System Supply Identifier | 827470 = Lawson ID"}]},{"description":"NAIL TI FLEX 3.0MMX400ROUND TI","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944793","type":"LOCAL"},{"code":"829382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944793 = Hospital System Supply Identifier | 829382 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 4003.5ELAS","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"944599","type":"LOCAL"},{"code":"829177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 944599 = Hospital System Supply Identifier | 829177 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.0X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054024","type":"LOCAL"},{"code":"876474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054024 = Hospital System Supply Identifier | 876474 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.5X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054025","type":"LOCAL"},{"code":"876475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054025 = Hospital System Supply Identifier | 876475 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356498","type":"LOCAL"},{"code":"1083545","type":"LOCAL"}],"standard_charges":[{"gross_charge":3980.5,"discounted_cash":1393.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356498 = Hospital System Supply Identifier | 1083545 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356384","type":"LOCAL"},{"code":"1083589","type":"LOCAL"}],"standard_charges":[{"gross_charge":3980.5,"discounted_cash":1393.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356384 = Hospital System Supply Identifier | 1083589 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356827","type":"LOCAL"},{"code":"1083729","type":"LOCAL"}],"standard_charges":[{"gross_charge":3980.5,"discounted_cash":1393.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356827 = Hospital System Supply Identifier | 1083729 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356434","type":"LOCAL"},{"code":"1083742","type":"LOCAL"}],"standard_charges":[{"gross_charge":3980.5,"discounted_cash":1393.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356434 = Hospital System Supply Identifier | 1083742 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356394","type":"LOCAL"},{"code":"1083558","type":"LOCAL"}],"standard_charges":[{"gross_charge":3980.5,"discounted_cash":1393.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356394 = Hospital System Supply Identifier | 1083558 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356352","type":"LOCAL"},{"code":"1083620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3980.5,"discounted_cash":1393.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356352 = Hospital System Supply Identifier | 1083620 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356949","type":"LOCAL"},{"code":"1083628","type":"LOCAL"}],"standard_charges":[{"gross_charge":1197.9,"discounted_cash":419.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356949 = Hospital System Supply Identifier | 1083628 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356625","type":"LOCAL"},{"code":"1083599","type":"LOCAL"}],"standard_charges":[{"gross_charge":1197.9,"discounted_cash":419.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356625 = Hospital System Supply Identifier | 1083599 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356970","type":"LOCAL"},{"code":"1083593","type":"LOCAL"}],"standard_charges":[{"gross_charge":1197.9,"discounted_cash":419.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356970 = Hospital System Supply Identifier | 1083593 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357118","type":"LOCAL"},{"code":"1083559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1267.2,"discounted_cash":443.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357118 = Hospital System Supply Identifier | 1083559 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356385","type":"LOCAL"},{"code":"1083659","type":"LOCAL"}],"standard_charges":[{"gross_charge":1267.2,"discounted_cash":443.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356385 = Hospital System Supply Identifier | 1083659 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356751","type":"LOCAL"},{"code":"1083689","type":"LOCAL"}],"standard_charges":[{"gross_charge":1267.2,"discounted_cash":443.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356751 = Hospital System Supply Identifier | 1083689 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357128","type":"LOCAL"},{"code":"1083616","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357128 = Hospital System Supply Identifier | 1083616 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356837","type":"LOCAL"},{"code":"1083710","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356837 = Hospital System Supply Identifier | 1083710 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356951","type":"LOCAL"},{"code":"1083716","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356951 = Hospital System Supply Identifier | 1083716 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356433","type":"LOCAL"},{"code":"1083733","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356433 = Hospital System Supply Identifier | 1083733 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356460","type":"LOCAL"},{"code":"1083736","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356460 = Hospital System Supply Identifier | 1083736 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357071","type":"LOCAL"},{"code":"1083723","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357071 = Hospital System Supply Identifier | 1083723 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356363","type":"LOCAL"},{"code":"1083635","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356363 = Hospital System Supply Identifier | 1083635 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356369","type":"LOCAL"},{"code":"1083707","type":"LOCAL"}],"standard_charges":[{"gross_charge":4184.75,"discounted_cash":1464.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356369 = Hospital System Supply Identifier | 1083707 = Lawson ID"}]},{"description":"GUIDE WIRE 1.6MMX150SMOOTH","code_information":[{"code":"Sx00-1005-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"942666","type":"LOCAL"},{"code":"827218","type":"LOCAL"}],"standard_charges":[{"gross_charge":178.77,"discounted_cash":62.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 942666 = Hospital System Supply Identifier | 827218 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 4HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054027","type":"LOCAL"},{"code":"876477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1296.7,"discounted_cash":453.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054027 = Hospital System Supply Identifier | 876477 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 6HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054028","type":"LOCAL"},{"code":"876478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1360.95,"discounted_cash":476.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054028 = Hospital System Supply Identifier | 876478 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 7HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054029","type":"LOCAL"},{"code":"876479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1425.2,"discounted_cash":498.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054029 = Hospital System Supply Identifier | 876479 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 8HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054030","type":"LOCAL"},{"code":"876480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1425.2,"discounted_cash":498.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054030 = Hospital System Supply Identifier | 876480 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 10HL","code_information":[{"code":"Sx00-1005-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054031","type":"LOCAL"},{"code":"876481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1538.21,"discounted_cash":538.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054031 = Hospital System Supply Identifier | 876481 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 6HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054034","type":"LOCAL"},{"code":"876484","type":"LOCAL"}],"standard_charges":[{"gross_charge":3443.71,"discounted_cash":1205.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054034 = Hospital System Supply Identifier | 876484 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 8HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054036","type":"LOCAL"},{"code":"876486","type":"LOCAL"}],"standard_charges":[{"gross_charge":3506.01,"discounted_cash":1227.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054036 = Hospital System Supply Identifier | 876486 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 7HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054035","type":"LOCAL"},{"code":"876485","type":"LOCAL"}],"standard_charges":[{"gross_charge":3506.01,"discounted_cash":1227.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054035 = Hospital System Supply Identifier | 876485 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 5HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054033","type":"LOCAL"},{"code":"876483","type":"LOCAL"}],"standard_charges":[{"gross_charge":3381.4,"discounted_cash":1183.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054033 = Hospital System Supply Identifier | 876483 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 4HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054032","type":"LOCAL"},{"code":"876482","type":"LOCAL"}],"standard_charges":[{"gross_charge":3319.1,"discounted_cash":1161.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054032 = Hospital System Supply Identifier | 876482 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING 12-HOLE","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357185","type":"LOCAL"},{"code":"1083724","type":"LOCAL"}],"standard_charges":[{"gross_charge":3966.25,"discounted_cash":1388.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357185 = Hospital System Supply Identifier | 1083724 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 10HL","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054037","type":"LOCAL"},{"code":"876487","type":"LOCAL"}],"standard_charges":[{"gross_charge":3627.6,"discounted_cash":1269.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054037 = Hospital System Supply Identifier | 876487 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 4HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054038","type":"LOCAL"},{"code":"876488","type":"LOCAL"}],"standard_charges":[{"gross_charge":2472.33,"discounted_cash":865.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054038 = Hospital System Supply Identifier | 876488 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 8HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054039","type":"LOCAL"},{"code":"876489","type":"LOCAL"}],"standard_charges":[{"gross_charge":2563.9,"discounted_cash":897.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054039 = Hospital System Supply Identifier | 876489 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 12H","code_information":[{"code":"Sx00-1005-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054040","type":"LOCAL"},{"code":"876490","type":"LOCAL"}],"standard_charges":[{"gross_charge":3648.86,"discounted_cash":1277.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054040 = Hospital System Supply Identifier | 876490 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X8MM","code_information":[{"code":"Sx00-1005-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054041","type":"LOCAL"},{"code":"876491","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054041 = Hospital System Supply Identifier | 876491 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X18MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054046","type":"LOCAL"},{"code":"876496","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054046 = Hospital System Supply Identifier | 876496 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X14MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054044","type":"LOCAL"},{"code":"876494","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054044 = Hospital System Supply Identifier | 876494 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X16MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054045","type":"LOCAL"},{"code":"876495","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054045 = Hospital System Supply Identifier | 876495 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X12MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054043","type":"LOCAL"},{"code":"876493","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054043 = Hospital System Supply Identifier | 876493 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X10MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054042","type":"LOCAL"},{"code":"876492","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054042 = Hospital System Supply Identifier | 876492 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X20MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054047","type":"LOCAL"},{"code":"876497","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054047 = Hospital System Supply Identifier | 876497 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X22MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054048","type":"LOCAL"},{"code":"876498","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054048 = Hospital System Supply Identifier | 876498 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X24MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054049","type":"LOCAL"},{"code":"876499","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054049 = Hospital System Supply Identifier | 876499 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X26MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054050","type":"LOCAL"},{"code":"876500","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054050 = Hospital System Supply Identifier | 876500 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X28MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054051","type":"LOCAL"},{"code":"876501","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054051 = Hospital System Supply Identifier | 876501 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X38MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054056","type":"LOCAL"},{"code":"876506","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054056 = Hospital System Supply Identifier | 876506 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X36MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054055","type":"LOCAL"},{"code":"876505","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054055 = Hospital System Supply Identifier | 876505 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X32MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054053","type":"LOCAL"},{"code":"876503","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054053 = Hospital System Supply Identifier | 876503 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X30MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054052","type":"LOCAL"},{"code":"876502","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054052 = Hospital System Supply Identifier | 876502 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X34MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054054","type":"LOCAL"},{"code":"876504","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054054 = Hospital System Supply Identifier | 876504 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X40MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054057","type":"LOCAL"},{"code":"876507","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054057 = Hospital System Supply Identifier | 876507 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X45MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054058","type":"LOCAL"},{"code":"876508","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054058 = Hospital System Supply Identifier | 876508 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X50MM","code_information":[{"code":"Sx00-1005-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054059","type":"LOCAL"},{"code":"876509","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054059 = Hospital System Supply Identifier | 876509 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X8MM","code_information":[{"code":"Sx00-1005-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054060","type":"LOCAL"},{"code":"876510","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054060 = Hospital System Supply Identifier | 876510 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X16MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054064","type":"LOCAL"},{"code":"876514","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054064 = Hospital System Supply Identifier | 876514 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X14MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054063","type":"LOCAL"},{"code":"876513","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054063 = Hospital System Supply Identifier | 876513 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X18MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054065","type":"LOCAL"},{"code":"876515","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054065 = Hospital System Supply Identifier | 876515 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X10MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054061","type":"LOCAL"},{"code":"876511","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054061 = Hospital System Supply Identifier | 876511 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X12MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054062","type":"LOCAL"},{"code":"876512","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054062 = Hospital System Supply Identifier | 876512 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X20MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054066","type":"LOCAL"},{"code":"876516","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054066 = Hospital System Supply Identifier | 876516 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X22MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054067","type":"LOCAL"},{"code":"876517","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054067 = Hospital System Supply Identifier | 876517 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X24MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054068","type":"LOCAL"},{"code":"876518","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054068 = Hospital System Supply Identifier | 876518 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X26MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054069","type":"LOCAL"},{"code":"876519","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054069 = Hospital System Supply Identifier | 876519 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X28MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054070","type":"LOCAL"},{"code":"876520","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054070 = Hospital System Supply Identifier | 876520 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X30MM","code_information":[{"code":"Sx00-1005-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054071","type":"LOCAL"},{"code":"876521","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054071 = Hospital System Supply Identifier | 876521 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 9HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054076","type":"LOCAL"},{"code":"876526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1696.46,"discounted_cash":593.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054076 = Hospital System Supply Identifier | 876526 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 8HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054075","type":"LOCAL"},{"code":"876525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1617.95,"discounted_cash":566.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054075 = Hospital System Supply Identifier | 876525 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 7HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054074","type":"LOCAL"},{"code":"876524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1617.95,"discounted_cash":566.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054074 = Hospital System Supply Identifier | 876524 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 4HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054072","type":"LOCAL"},{"code":"876522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1489.45,"discounted_cash":521.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054072 = Hospital System Supply Identifier | 876522 = Lawson ID"}]},{"description":"PLATE BONE 1/3 TUBULAR NSTRL 5","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942929","type":"LOCAL"},{"code":"827489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1553.7,"discounted_cash":543.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 942929 = Hospital System Supply Identifier | 827489 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 6HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054073","type":"LOCAL"},{"code":"876523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1553.7,"discounted_cash":543.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054073 = Hospital System Supply Identifier | 876523 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 10HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054077","type":"LOCAL"},{"code":"876527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1825.98,"discounted_cash":639.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054077 = Hospital System Supply Identifier | 876527 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 12HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054078","type":"LOCAL"},{"code":"876528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1838.38,"discounted_cash":643.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054078 = Hospital System Supply Identifier | 876528 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 4HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054079","type":"LOCAL"},{"code":"876529","type":"LOCAL"}],"standard_charges":[{"gross_charge":2364.83,"discounted_cash":827.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054079 = Hospital System Supply Identifier | 876529 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 5HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054080","type":"LOCAL"},{"code":"876530","type":"LOCAL"}],"standard_charges":[{"gross_charge":2437.99,"discounted_cash":853.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054080 = Hospital System Supply Identifier | 876530 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 6HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054081","type":"LOCAL"},{"code":"876531","type":"LOCAL"}],"standard_charges":[{"gross_charge":2529.56,"discounted_cash":885.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054081 = Hospital System Supply Identifier | 876531 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 7HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054082","type":"LOCAL"},{"code":"876532","type":"LOCAL"}],"standard_charges":[{"gross_charge":2626.85,"discounted_cash":919.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054082 = Hospital System Supply Identifier | 876532 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 8HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054083","type":"LOCAL"},{"code":"876533","type":"LOCAL"}],"standard_charges":[{"gross_charge":2626.85,"discounted_cash":919.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054083 = Hospital System Supply Identifier | 876533 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 18HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054087","type":"LOCAL"},{"code":"876537","type":"LOCAL"}],"standard_charges":[{"gross_charge":3144.86,"discounted_cash":1100.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054087 = Hospital System Supply Identifier | 876537 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 12HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054085","type":"LOCAL"},{"code":"876535","type":"LOCAL"}],"standard_charges":[{"gross_charge":2986.19,"discounted_cash":1045.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054085 = Hospital System Supply Identifier | 876535 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 10HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054084","type":"LOCAL"},{"code":"876534","type":"LOCAL"}],"standard_charges":[{"gross_charge":2718.42,"discounted_cash":951.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054084 = Hospital System Supply Identifier | 876534 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 16HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054086","type":"LOCAL"},{"code":"876536","type":"LOCAL"}],"standard_charges":[{"gross_charge":2986.19,"discounted_cash":1045.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054086 = Hospital System Supply Identifier | 876536 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 20HL","code_information":[{"code":"Sx00-1005-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054088","type":"LOCAL"},{"code":"876538","type":"LOCAL"}],"standard_charges":[{"gross_charge":3144.86,"discounted_cash":1100.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054088 = Hospital System Supply Identifier | 876538 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054089","type":"LOCAL"},{"code":"876539","type":"LOCAL"}],"standard_charges":[{"gross_charge":3562.65,"discounted_cash":1246.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054089 = Hospital System Supply Identifier | 876539 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054090","type":"LOCAL"},{"code":"876540","type":"LOCAL"}],"standard_charges":[{"gross_charge":3957.13,"discounted_cash":1385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054090 = Hospital System Supply Identifier | 876540 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054091","type":"LOCAL"},{"code":"876541","type":"LOCAL"}],"standard_charges":[{"gross_charge":4338.27,"discounted_cash":1518.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054091 = Hospital System Supply Identifier | 876541 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 16 HOLE","code_information":[{"code":"Sx00-1005-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054092","type":"LOCAL"},{"code":"876542","type":"LOCAL"}],"standard_charges":[{"gross_charge":4726.25,"discounted_cash":1654.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054092 = Hospital System Supply Identifier | 876542 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 3HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054093","type":"LOCAL"},{"code":"876543","type":"LOCAL"}],"standard_charges":[{"gross_charge":2684.08,"discounted_cash":939.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054093 = Hospital System Supply Identifier | 876543 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 5HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054094","type":"LOCAL"},{"code":"876544","type":"LOCAL"}],"standard_charges":[{"gross_charge":2872.94,"discounted_cash":1005.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054094 = Hospital System Supply Identifier | 876544 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 7HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054097","type":"LOCAL"},{"code":"876547","type":"LOCAL"}],"standard_charges":[{"gross_charge":3653.28,"discounted_cash":1278.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054097 = Hospital System Supply Identifier | 876547 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 5HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054096","type":"LOCAL"},{"code":"876546","type":"LOCAL"}],"standard_charges":[{"gross_charge":2872.94,"discounted_cash":1005.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054096 = Hospital System Supply Identifier | 876546 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 3HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054095","type":"LOCAL"},{"code":"876545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2684.08,"discounted_cash":939.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054095 = Hospital System Supply Identifier | 876545 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 10","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054098","type":"LOCAL"},{"code":"876548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054098 = Hospital System Supply Identifier | 876548 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 12","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054099","type":"LOCAL"},{"code":"876549","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054099 = Hospital System Supply Identifier | 876549 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 14","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054100","type":"LOCAL"},{"code":"876550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054100 = Hospital System Supply Identifier | 876550 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054101","type":"LOCAL"},{"code":"876551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054101 = Hospital System Supply Identifier | 876551 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054102","type":"LOCAL"},{"code":"876552","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054102 = Hospital System Supply Identifier | 876552 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054107","type":"LOCAL"},{"code":"876557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054107 = Hospital System Supply Identifier | 876557 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054106","type":"LOCAL"},{"code":"876556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054106 = Hospital System Supply Identifier | 876556 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054105","type":"LOCAL"},{"code":"876555","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054105 = Hospital System Supply Identifier | 876555 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054104","type":"LOCAL"},{"code":"876554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054104 = Hospital System Supply Identifier | 876554 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054103","type":"LOCAL"},{"code":"876553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054103 = Hospital System Supply Identifier | 876553 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054108","type":"LOCAL"},{"code":"876558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054108 = Hospital System Supply Identifier | 876558 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054109","type":"LOCAL"},{"code":"876559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054109 = Hospital System Supply Identifier | 876559 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054110","type":"LOCAL"},{"code":"876560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054110 = Hospital System Supply Identifier | 876560 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054111","type":"LOCAL"},{"code":"876561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054111 = Hospital System Supply Identifier | 876561 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054112","type":"LOCAL"},{"code":"876562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054112 = Hospital System Supply Identifier | 876562 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054113","type":"LOCAL"},{"code":"876563","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054113 = Hospital System Supply Identifier | 876563 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054114","type":"LOCAL"},{"code":"876564","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054114 = Hospital System Supply Identifier | 876564 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054115","type":"LOCAL"},{"code":"876565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054115 = Hospital System Supply Identifier | 876565 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054116","type":"LOCAL"},{"code":"876566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054116 = Hospital System Supply Identifier | 876566 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054117","type":"LOCAL"},{"code":"876567","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054117 = Hospital System Supply Identifier | 876567 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054118","type":"LOCAL"},{"code":"876568","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054118 = Hospital System Supply Identifier | 876568 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054119","type":"LOCAL"},{"code":"876569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054119 = Hospital System Supply Identifier | 876569 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054120","type":"LOCAL"},{"code":"876570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054120 = Hospital System Supply Identifier | 876570 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054121","type":"LOCAL"},{"code":"876571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054121 = Hospital System Supply Identifier | 876571 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054122","type":"LOCAL"},{"code":"876572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054122 = Hospital System Supply Identifier | 876572 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054123","type":"LOCAL"},{"code":"876573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054123 = Hospital System Supply Identifier | 876573 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054124","type":"LOCAL"},{"code":"876574","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054124 = Hospital System Supply Identifier | 876574 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054129","type":"LOCAL"},{"code":"876579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054129 = Hospital System Supply Identifier | 876579 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054127","type":"LOCAL"},{"code":"876577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054127 = Hospital System Supply Identifier | 876577 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054128","type":"LOCAL"},{"code":"876578","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054128 = Hospital System Supply Identifier | 876578 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054126","type":"LOCAL"},{"code":"876576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054126 = Hospital System Supply Identifier | 876576 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054125","type":"LOCAL"},{"code":"876575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054125 = Hospital System Supply Identifier | 876575 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054130","type":"LOCAL"},{"code":"876580","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054130 = Hospital System Supply Identifier | 876580 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054131","type":"LOCAL"},{"code":"876581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054131 = Hospital System Supply Identifier | 876581 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054132","type":"LOCAL"},{"code":"876582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054132 = Hospital System Supply Identifier | 876582 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054133","type":"LOCAL"},{"code":"876583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054133 = Hospital System Supply Identifier | 876583 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054134","type":"LOCAL"},{"code":"876584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054134 = Hospital System Supply Identifier | 876584 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054135","type":"LOCAL"},{"code":"876585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054135 = Hospital System Supply Identifier | 876585 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054141","type":"LOCAL"},{"code":"876591","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054141 = Hospital System Supply Identifier | 876591 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054140","type":"LOCAL"},{"code":"876590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054140 = Hospital System Supply Identifier | 876590 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054139","type":"LOCAL"},{"code":"876589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054139 = Hospital System Supply Identifier | 876589 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054138","type":"LOCAL"},{"code":"876588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054138 = Hospital System Supply Identifier | 876588 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054137","type":"LOCAL"},{"code":"876587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054137 = Hospital System Supply Identifier | 876587 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054136","type":"LOCAL"},{"code":"876586","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054136 = Hospital System Supply Identifier | 876586 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054142","type":"LOCAL"},{"code":"876592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054142 = Hospital System Supply Identifier | 876592 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054143","type":"LOCAL"},{"code":"876593","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054143 = Hospital System Supply Identifier | 876593 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054144","type":"LOCAL"},{"code":"876594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054144 = Hospital System Supply Identifier | 876594 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054145","type":"LOCAL"},{"code":"876595","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054145 = Hospital System Supply Identifier | 876595 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054146","type":"LOCAL"},{"code":"876596","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054146 = Hospital System Supply Identifier | 876596 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054147","type":"LOCAL"},{"code":"876597","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054147 = Hospital System Supply Identifier | 876597 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054150","type":"LOCAL"},{"code":"876600","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054150 = Hospital System Supply Identifier | 876600 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054148","type":"LOCAL"},{"code":"876598","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054148 = Hospital System Supply Identifier | 876598 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054149","type":"LOCAL"},{"code":"876599","type":"LOCAL"}],"standard_charges":[{"gross_charge":5115.0,"discounted_cash":1790.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054149 = Hospital System Supply Identifier | 876599 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054151","type":"LOCAL"},{"code":"876601","type":"LOCAL"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054151 = Hospital System Supply Identifier | 876601 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054152","type":"LOCAL"},{"code":"876602","type":"LOCAL"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054152 = Hospital System Supply Identifier | 876602 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054153","type":"LOCAL"},{"code":"876603","type":"LOCAL"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054153 = Hospital System Supply Identifier | 876603 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054154","type":"LOCAL"},{"code":"876604","type":"LOCAL"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054154 = Hospital System Supply Identifier | 876604 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054155","type":"LOCAL"},{"code":"876605","type":"LOCAL"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054155 = Hospital System Supply Identifier | 876605 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054156","type":"LOCAL"},{"code":"876606","type":"LOCAL"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":2093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054156 = Hospital System Supply Identifier | 876606 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 99MM","code_information":[{"code":"Sx00-1005-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054157","type":"LOCAL"},{"code":"876607","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054157 = Hospital System Supply Identifier | 876607 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 112MM","code_information":[{"code":"Sx00-1005-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054158","type":"LOCAL"},{"code":"876608","type":"LOCAL"}],"standard_charges":[{"gross_charge":6750.0,"discounted_cash":2362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054158 = Hospital System Supply Identifier | 876608 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 12MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054159","type":"LOCAL"},{"code":"876609","type":"LOCAL"}],"standard_charges":[{"gross_charge":6804.0,"discounted_cash":2381.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054159 = Hospital System Supply Identifier | 876609 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 15MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054160","type":"LOCAL"},{"code":"876610","type":"LOCAL"}],"standard_charges":[{"gross_charge":6804.0,"discounted_cash":2381.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054160 = Hospital System Supply Identifier | 876610 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 18MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054161","type":"LOCAL"},{"code":"876611","type":"LOCAL"}],"standard_charges":[{"gross_charge":6804.0,"discounted_cash":2381.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054161 = Hospital System Supply Identifier | 876611 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 21MM","code_information":[{"code":"Sx00-1007-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054162","type":"LOCAL"},{"code":"876612","type":"LOCAL"}],"standard_charges":[{"gross_charge":6804.0,"discounted_cash":2381.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054162 = Hospital System Supply Identifier | 876612 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 12MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054163","type":"LOCAL"},{"code":"876613","type":"LOCAL"}],"standard_charges":[{"gross_charge":7686.0,"discounted_cash":2690.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054163 = Hospital System Supply Identifier | 876613 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 15MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054164","type":"LOCAL"},{"code":"876614","type":"LOCAL"}],"standard_charges":[{"gross_charge":7686.0,"discounted_cash":2690.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054164 = Hospital System Supply Identifier | 876614 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054165","type":"LOCAL"},{"code":"876615","type":"LOCAL"}],"standard_charges":[{"gross_charge":8099.0,"discounted_cash":2834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054165 = Hospital System Supply Identifier | 876615 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054167","type":"LOCAL"},{"code":"876617","type":"LOCAL"}],"standard_charges":[{"gross_charge":8099.0,"discounted_cash":2834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054167 = Hospital System Supply Identifier | 876617 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054166","type":"LOCAL"},{"code":"876616","type":"LOCAL"}],"standard_charges":[{"gross_charge":8099.0,"discounted_cash":2834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054166 = Hospital System Supply Identifier | 876616 = Lawson ID"}]},{"description":"PLATE CLOVER 2.7MM 4HL","code_information":[{"code":"Sx00-1007-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054168","type":"LOCAL"},{"code":"876618","type":"LOCAL"}],"standard_charges":[{"gross_charge":5728.8,"discounted_cash":2005.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054168 = Hospital System Supply Identifier | 876618 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054170","type":"LOCAL"},{"code":"876620","type":"LOCAL"}],"standard_charges":[{"gross_charge":8348.2,"discounted_cash":2921.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054170 = Hospital System Supply Identifier | 876620 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 15MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054169","type":"LOCAL"},{"code":"876619","type":"LOCAL"}],"standard_charges":[{"gross_charge":8348.2,"discounted_cash":2921.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054169 = Hospital System Supply Identifier | 876619 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054171","type":"LOCAL"},{"code":"876621","type":"LOCAL"}],"standard_charges":[{"gross_charge":8348.2,"discounted_cash":2921.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054171 = Hospital System Supply Identifier | 876621 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054172","type":"LOCAL"},{"code":"876622","type":"LOCAL"}],"standard_charges":[{"gross_charge":8348.2,"discounted_cash":2921.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054172 = Hospital System Supply Identifier | 876622 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 27MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054173","type":"LOCAL"},{"code":"876623","type":"LOCAL"}],"standard_charges":[{"gross_charge":8348.2,"discounted_cash":2921.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054173 = Hospital System Supply Identifier | 876623 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 30MM","code_information":[{"code":"Sx00-1007-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054174","type":"LOCAL"},{"code":"876624","type":"LOCAL"}],"standard_charges":[{"gross_charge":8348.2,"discounted_cash":2921.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054174 = Hospital System Supply Identifier | 876624 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 2HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054175","type":"LOCAL"},{"code":"876625","type":"LOCAL"}],"standard_charges":[{"gross_charge":5189.4,"discounted_cash":1816.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054175 = Hospital System Supply Identifier | 876625 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 4HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054176","type":"LOCAL"},{"code":"876626","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054176 = Hospital System Supply Identifier | 876626 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 6HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054177","type":"LOCAL"},{"code":"876627","type":"LOCAL"}],"standard_charges":[{"gross_charge":7596.0,"discounted_cash":2658.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054177 = Hospital System Supply Identifier | 876627 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 8HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054178","type":"LOCAL"},{"code":"876628","type":"LOCAL"}],"standard_charges":[{"gross_charge":8757.6,"discounted_cash":3065.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054178 = Hospital System Supply Identifier | 876628 = Lawson ID"}]},{"description":"ANGLE IRON 2.7MM 5MM","code_information":[{"code":"Sx00-1007-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054179","type":"LOCAL"},{"code":"876629","type":"LOCAL"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":2254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054179 = Hospital System Supply Identifier | 876629 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 2MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054180","type":"LOCAL"},{"code":"876630","type":"LOCAL"}],"standard_charges":[{"gross_charge":8722.0,"discounted_cash":3052.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054180 = Hospital System Supply Identifier | 876630 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054181","type":"LOCAL"},{"code":"876631","type":"LOCAL"}],"standard_charges":[{"gross_charge":8993.6,"discounted_cash":3147.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054181 = Hospital System Supply Identifier | 876631 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 15MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054182","type":"LOCAL"},{"code":"876632","type":"LOCAL"}],"standard_charges":[{"gross_charge":8099.0,"discounted_cash":2834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054182 = Hospital System Supply Identifier | 876632 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 18MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054183","type":"LOCAL"},{"code":"876633","type":"LOCAL"}],"standard_charges":[{"gross_charge":8099.0,"discounted_cash":2834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054183 = Hospital System Supply Identifier | 876633 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 21MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054184","type":"LOCAL"},{"code":"876634","type":"LOCAL"}],"standard_charges":[{"gross_charge":8099.0,"discounted_cash":2834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054184 = Hospital System Supply Identifier | 876634 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 24MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054185","type":"LOCAL"},{"code":"876635","type":"LOCAL"}],"standard_charges":[{"gross_charge":8099.0,"discounted_cash":2834.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054185 = Hospital System Supply Identifier | 876635 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 15MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054186","type":"LOCAL"},{"code":"876636","type":"LOCAL"}],"standard_charges":[{"gross_charge":9011.2,"discounted_cash":3153.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054186 = Hospital System Supply Identifier | 876636 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 18MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054187","type":"LOCAL"},{"code":"876637","type":"LOCAL"}],"standard_charges":[{"gross_charge":9011.2,"discounted_cash":3153.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054187 = Hospital System Supply Identifier | 876637 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054190","type":"LOCAL"},{"code":"876640","type":"LOCAL"}],"standard_charges":[{"gross_charge":9609.6,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054190 = Hospital System Supply Identifier | 876640 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054189","type":"LOCAL"},{"code":"876639","type":"LOCAL"}],"standard_charges":[{"gross_charge":9609.6,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054189 = Hospital System Supply Identifier | 876639 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054188","type":"LOCAL"},{"code":"876638","type":"LOCAL"}],"standard_charges":[{"gross_charge":9609.6,"discounted_cash":3363.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054188 = Hospital System Supply Identifier | 876638 = Lawson ID"}]},{"description":"PLATE CLOVER 3.5MM 4HL","code_information":[{"code":"Sx00-1007-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054191","type":"LOCAL"},{"code":"876641","type":"LOCAL"}],"standard_charges":[{"gross_charge":8232.5,"discounted_cash":2881.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054191 = Hospital System Supply Identifier | 876641 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 15MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054192","type":"LOCAL"},{"code":"876642","type":"LOCAL"}],"standard_charges":[{"gross_charge":9796.2,"discounted_cash":3428.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054192 = Hospital System Supply Identifier | 876642 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 18MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054193","type":"LOCAL"},{"code":"876643","type":"LOCAL"}],"standard_charges":[{"gross_charge":9796.2,"discounted_cash":3428.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054193 = Hospital System Supply Identifier | 876643 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054194","type":"LOCAL"},{"code":"876644","type":"LOCAL"}],"standard_charges":[{"gross_charge":9796.2,"discounted_cash":3428.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054194 = Hospital System Supply Identifier | 876644 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054195","type":"LOCAL"},{"code":"876645","type":"LOCAL"}],"standard_charges":[{"gross_charge":9796.2,"discounted_cash":3428.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054195 = Hospital System Supply Identifier | 876645 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054196","type":"LOCAL"},{"code":"876646","type":"LOCAL"}],"standard_charges":[{"gross_charge":9796.2,"discounted_cash":3428.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054196 = Hospital System Supply Identifier | 876646 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 30MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054197","type":"LOCAL"},{"code":"876647","type":"LOCAL"}],"standard_charges":[{"gross_charge":9796.2,"discounted_cash":3428.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054197 = Hospital System Supply Identifier | 876647 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 33MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054198","type":"LOCAL"},{"code":"876648","type":"LOCAL"}],"standard_charges":[{"gross_charge":9796.2,"discounted_cash":3428.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054198 = Hospital System Supply Identifier | 876648 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 2HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054199","type":"LOCAL"},{"code":"876649","type":"LOCAL"}],"standard_charges":[{"gross_charge":6164.0,"discounted_cash":2157.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054199 = Hospital System Supply Identifier | 876649 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054200","type":"LOCAL"},{"code":"876650","type":"LOCAL"}],"standard_charges":[{"gross_charge":7560.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054200 = Hospital System Supply Identifier | 876650 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054201","type":"LOCAL"},{"code":"876651","type":"LOCAL"}],"standard_charges":[{"gross_charge":8888.0,"discounted_cash":3110.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054201 = Hospital System Supply Identifier | 876651 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054202","type":"LOCAL"},{"code":"876652","type":"LOCAL"}],"standard_charges":[{"gross_charge":10266.0,"discounted_cash":3593.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054202 = Hospital System Supply Identifier | 876652 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 6MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054204","type":"LOCAL"},{"code":"876654","type":"LOCAL"}],"standard_charges":[{"gross_charge":10614.0,"discounted_cash":3714.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054204 = Hospital System Supply Identifier | 876654 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054203","type":"LOCAL"},{"code":"876653","type":"LOCAL"}],"standard_charges":[{"gross_charge":10231.2,"discounted_cash":3580.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054203 = Hospital System Supply Identifier | 876653 = Lawson ID"}]},{"description":"ANGLE IRON 3.5MM 6MM","code_information":[{"code":"Sx00-1007-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054205","type":"LOCAL"},{"code":"876655","type":"LOCAL"}],"standard_charges":[{"gross_charge":7560.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054205 = Hospital System Supply Identifier | 876655 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X8MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054207","type":"LOCAL"},{"code":"876657","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054207 = Hospital System Supply Identifier | 876657 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X6MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054206","type":"LOCAL"},{"code":"876656","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054206 = Hospital System Supply Identifier | 876656 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X14MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054210","type":"LOCAL"},{"code":"876660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054210 = Hospital System Supply Identifier | 876660 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X16MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054211","type":"LOCAL"},{"code":"876661","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054211 = Hospital System Supply Identifier | 876661 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X10MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054208","type":"LOCAL"},{"code":"876658","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054208 = Hospital System Supply Identifier | 876658 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X12MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054209","type":"LOCAL"},{"code":"876659","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054209 = Hospital System Supply Identifier | 876659 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X18MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054212","type":"LOCAL"},{"code":"876662","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054212 = Hospital System Supply Identifier | 876662 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X28MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054217","type":"LOCAL"},{"code":"876667","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054217 = Hospital System Supply Identifier | 876667 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X26MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054216","type":"LOCAL"},{"code":"876666","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054216 = Hospital System Supply Identifier | 876666 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X20MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054213","type":"LOCAL"},{"code":"876663","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054213 = Hospital System Supply Identifier | 876663 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X22MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054214","type":"LOCAL"},{"code":"876664","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054214 = Hospital System Supply Identifier | 876664 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X24MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054215","type":"LOCAL"},{"code":"876665","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054215 = Hospital System Supply Identifier | 876665 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X30MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054218","type":"LOCAL"},{"code":"876668","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054218 = Hospital System Supply Identifier | 876668 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X32MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054219","type":"LOCAL"},{"code":"876669","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054219 = Hospital System Supply Identifier | 876669 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X34MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054220","type":"LOCAL"},{"code":"876670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054220 = Hospital System Supply Identifier | 876670 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X36MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054221","type":"LOCAL"},{"code":"876671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054221 = Hospital System Supply Identifier | 876671 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X38MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054222","type":"LOCAL"},{"code":"876672","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054222 = Hospital System Supply Identifier | 876672 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X48MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054225","type":"LOCAL"},{"code":"876675","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054225 = Hospital System Supply Identifier | 876675 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X44MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054224","type":"LOCAL"},{"code":"876674","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054224 = Hospital System Supply Identifier | 876674 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X40MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054223","type":"LOCAL"},{"code":"876673","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054223 = Hospital System Supply Identifier | 876673 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X52MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054226","type":"LOCAL"},{"code":"876676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054226 = Hospital System Supply Identifier | 876676 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X56MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054227","type":"LOCAL"},{"code":"876677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054227 = Hospital System Supply Identifier | 876677 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X60MM","code_information":[{"code":"Sx00-1007-276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054228","type":"LOCAL"},{"code":"876678","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054228 = Hospital System Supply Identifier | 876678 = Lawson ID"}]},{"description":"SCREW CORT 2.7X6MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054229","type":"LOCAL"},{"code":"876679","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054229 = Hospital System Supply Identifier | 876679 = Lawson ID"}]},{"description":"SCREW CORT 2.7X8MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054230","type":"LOCAL"},{"code":"876680","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054230 = Hospital System Supply Identifier | 876680 = Lawson ID"}]},{"description":"SCREW CORT 2.7X16MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054234","type":"LOCAL"},{"code":"876684","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054234 = Hospital System Supply Identifier | 876684 = Lawson ID"}]},{"description":"SCREW CORT 2.7X14MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054233","type":"LOCAL"},{"code":"876683","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054233 = Hospital System Supply Identifier | 876683 = Lawson ID"}]},{"description":"SCREW CORT 2.7X18MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054235","type":"LOCAL"},{"code":"876685","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054235 = Hospital System Supply Identifier | 876685 = Lawson ID"}]},{"description":"SCREW CORT 2.7X10MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054231","type":"LOCAL"},{"code":"876681","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054231 = Hospital System Supply Identifier | 876681 = Lawson ID"}]},{"description":"SCREW CORT 2.7X12MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054232","type":"LOCAL"},{"code":"876682","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054232 = Hospital System Supply Identifier | 876682 = Lawson ID"}]},{"description":"SCREW CORT 2.7X20MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054236","type":"LOCAL"},{"code":"876686","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054236 = Hospital System Supply Identifier | 876686 = Lawson ID"}]},{"description":"SCREW CORT 2.7X22MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054237","type":"LOCAL"},{"code":"876687","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054237 = Hospital System Supply Identifier | 876687 = Lawson ID"}]},{"description":"SCREW CORT 2.7X24MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054238","type":"LOCAL"},{"code":"876688","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054238 = Hospital System Supply Identifier | 876688 = Lawson ID"}]},{"description":"SCREW CORT 2.7X26MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054239","type":"LOCAL"},{"code":"876689","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054239 = Hospital System Supply Identifier | 876689 = Lawson ID"}]},{"description":"SCREW CORT 2.7X28MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054240","type":"LOCAL"},{"code":"876690","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054240 = Hospital System Supply Identifier | 876690 = Lawson ID"}]},{"description":"SCREW CORT 2.7X38MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054245","type":"LOCAL"},{"code":"876695","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054245 = Hospital System Supply Identifier | 876695 = Lawson ID"}]},{"description":"SCREW CORT 2.7X34MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054243","type":"LOCAL"},{"code":"876693","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054243 = Hospital System Supply Identifier | 876693 = Lawson ID"}]},{"description":"SCREW CORT 2.7X36MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054244","type":"LOCAL"},{"code":"876694","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054244 = Hospital System Supply Identifier | 876694 = Lawson ID"}]},{"description":"SCREW CORT 2.7X30MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054241","type":"LOCAL"},{"code":"876691","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054241 = Hospital System Supply Identifier | 876691 = Lawson ID"}]},{"description":"SCREW CORT 2.7X32MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054242","type":"LOCAL"},{"code":"876692","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054242 = Hospital System Supply Identifier | 876692 = Lawson ID"}]},{"description":"SCREW CORT 2.7X40MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054246","type":"LOCAL"},{"code":"876696","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054246 = Hospital System Supply Identifier | 876696 = Lawson ID"}]},{"description":"SCREW CORT 2.7X44MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054247","type":"LOCAL"},{"code":"876697","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054247 = Hospital System Supply Identifier | 876697 = Lawson ID"}]},{"description":"SCREW CORT 2.7X48MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054248","type":"LOCAL"},{"code":"876698","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054248 = Hospital System Supply Identifier | 876698 = Lawson ID"}]},{"description":"SCREW CORT 2.7X52MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054249","type":"LOCAL"},{"code":"876699","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054249 = Hospital System Supply Identifier | 876699 = Lawson ID"}]},{"description":"SCREW CORT 2.7X56MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054250","type":"LOCAL"},{"code":"876700","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054250 = Hospital System Supply Identifier | 876700 = Lawson ID"}]},{"description":"SCREW CORT 2.7X60MM","code_information":[{"code":"Sx00-1007-286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054251","type":"LOCAL"},{"code":"876701","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054251 = Hospital System Supply Identifier | 876701 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X8MM","code_information":[{"code":"Sx00-1007-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054252","type":"LOCAL"},{"code":"876702","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054252 = Hospital System Supply Identifier | 876702 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X16MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054256","type":"LOCAL"},{"code":"876706","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054256 = Hospital System Supply Identifier | 876706 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X14MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054255","type":"LOCAL"},{"code":"876705","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054255 = Hospital System Supply Identifier | 876705 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X18MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054257","type":"LOCAL"},{"code":"876707","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054257 = Hospital System Supply Identifier | 876707 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X10MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054253","type":"LOCAL"},{"code":"876703","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054253 = Hospital System Supply Identifier | 876703 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X12MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054254","type":"LOCAL"},{"code":"876704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054254 = Hospital System Supply Identifier | 876704 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X20MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054258","type":"LOCAL"},{"code":"876708","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054258 = Hospital System Supply Identifier | 876708 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X22MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054259","type":"LOCAL"},{"code":"876709","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054259 = Hospital System Supply Identifier | 876709 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X24MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054260","type":"LOCAL"},{"code":"876710","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054260 = Hospital System Supply Identifier | 876710 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X26MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054261","type":"LOCAL"},{"code":"876711","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054261 = Hospital System Supply Identifier | 876711 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X28MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054262","type":"LOCAL"},{"code":"876712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054262 = Hospital System Supply Identifier | 876712 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X34MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054265","type":"LOCAL"},{"code":"876715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054265 = Hospital System Supply Identifier | 876715 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X38MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054267","type":"LOCAL"},{"code":"876717","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054267 = Hospital System Supply Identifier | 876717 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X30MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054263","type":"LOCAL"},{"code":"876713","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054263 = Hospital System Supply Identifier | 876713 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X32MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054264","type":"LOCAL"},{"code":"876714","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054264 = Hospital System Supply Identifier | 876714 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X36MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054266","type":"LOCAL"},{"code":"876716","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054266 = Hospital System Supply Identifier | 876716 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X40MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054268","type":"LOCAL"},{"code":"876718","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054268 = Hospital System Supply Identifier | 876718 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X44MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054269","type":"LOCAL"},{"code":"876719","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054269 = Hospital System Supply Identifier | 876719 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X48MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054270","type":"LOCAL"},{"code":"876720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054270 = Hospital System Supply Identifier | 876720 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X52MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054271","type":"LOCAL"},{"code":"876721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054271 = Hospital System Supply Identifier | 876721 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X56MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054272","type":"LOCAL"},{"code":"876722","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054272 = Hospital System Supply Identifier | 876722 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X60MM","code_information":[{"code":"Sx00-1007-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054273","type":"LOCAL"},{"code":"876723","type":"LOCAL"}],"standard_charges":[{"gross_charge":1564.2,"discounted_cash":547.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054273 = Hospital System Supply Identifier | 876723 = Lawson ID"}]},{"description":"SCREW CORT 3.5X8MM","code_information":[{"code":"Sx00-1007-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054274","type":"LOCAL"},{"code":"876724","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054274 = Hospital System Supply Identifier | 876724 = Lawson ID"}]},{"description":"SCREW CORT 3.5X16MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054278","type":"LOCAL"},{"code":"876728","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054278 = Hospital System Supply Identifier | 876728 = Lawson ID"}]},{"description":"SCREW CORT 3.5X18MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054279","type":"LOCAL"},{"code":"876729","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054279 = Hospital System Supply Identifier | 876729 = Lawson ID"}]},{"description":"SCREW CORT 3.5X14MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054277","type":"LOCAL"},{"code":"876727","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054277 = Hospital System Supply Identifier | 876727 = Lawson ID"}]},{"description":"SCREW CORT 3.5X10MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054275","type":"LOCAL"},{"code":"876725","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054275 = Hospital System Supply Identifier | 876725 = Lawson ID"}]},{"description":"SCREW CORT 3.5X12MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054276","type":"LOCAL"},{"code":"876726","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054276 = Hospital System Supply Identifier | 876726 = Lawson ID"}]},{"description":"SCREW CORT 3.5X20MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054280","type":"LOCAL"},{"code":"876730","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054280 = Hospital System Supply Identifier | 876730 = Lawson ID"}]},{"description":"SCREW CORT 3.5X22MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054281","type":"LOCAL"},{"code":"876731","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054281 = Hospital System Supply Identifier | 876731 = Lawson ID"}]},{"description":"SCREW CORT 3.5X24MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054282","type":"LOCAL"},{"code":"876732","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054282 = Hospital System Supply Identifier | 876732 = Lawson ID"}]},{"description":"SCREW CORT 3.5X26MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054283","type":"LOCAL"},{"code":"876733","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054283 = Hospital System Supply Identifier | 876733 = Lawson ID"}]},{"description":"SCREW CORT 3.5X28MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054284","type":"LOCAL"},{"code":"876734","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054284 = Hospital System Supply Identifier | 876734 = Lawson ID"}]},{"description":"SCREW CORT 3.5X38MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054289","type":"LOCAL"},{"code":"876739","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054289 = Hospital System Supply Identifier | 876739 = Lawson ID"}]},{"description":"SCREW CORT 3.5X34MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054287","type":"LOCAL"},{"code":"876737","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054287 = Hospital System Supply Identifier | 876737 = Lawson ID"}]},{"description":"SCREW CORT 3.5X36MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054288","type":"LOCAL"},{"code":"876738","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054288 = Hospital System Supply Identifier | 876738 = Lawson ID"}]},{"description":"SCREW CORT 3.5X30MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054285","type":"LOCAL"},{"code":"876735","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054285 = Hospital System Supply Identifier | 876735 = Lawson ID"}]},{"description":"SCREW CORT 3.5X32MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054286","type":"LOCAL"},{"code":"876736","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054286 = Hospital System Supply Identifier | 876736 = Lawson ID"}]},{"description":"SCREW CORT 3.5X40MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054290","type":"LOCAL"},{"code":"876740","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054290 = Hospital System Supply Identifier | 876740 = Lawson ID"}]},{"description":"SCREW CORT 3.5X44MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054291","type":"LOCAL"},{"code":"876741","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054291 = Hospital System Supply Identifier | 876741 = Lawson ID"}]},{"description":"SCREW CORT 3.5X48MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054292","type":"LOCAL"},{"code":"876742","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054292 = Hospital System Supply Identifier | 876742 = Lawson ID"}]},{"description":"SCREW CORT 3.5X52MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054293","type":"LOCAL"},{"code":"876743","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054293 = Hospital System Supply Identifier | 876743 = Lawson ID"}]},{"description":"SCREW CORT 3.5X56MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054294","type":"LOCAL"},{"code":"876744","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054294 = Hospital System Supply Identifier | 876744 = Lawson ID"}]},{"description":"SCREW CORT 3.5X60MM","code_information":[{"code":"Sx00-1007-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054295","type":"LOCAL"},{"code":"876745","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054295 = Hospital System Supply Identifier | 876745 = Lawson ID"}]},{"description":"PLATE LVL1 MINI STR 20HL 100MM","code_information":[{"code":"Sx00-101-30-9","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700594","type":"LOCAL"},{"code":"723730","type":"LOCAL"}],"standard_charges":[{"gross_charge":411.65,"discounted_cash":144.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 700594 = Hospital System Supply Identifier | 723730 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 20MM","code_information":[{"code":"Sx00-101-56-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700596","type":"LOCAL"},{"code":"723732","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.95,"discounted_cash":181.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 700596 = Hospital System Supply Identifier | 723732 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 20MM","code_information":[{"code":"Sx00-101-57-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700597","type":"LOCAL"},{"code":"723733","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.95,"discounted_cash":181.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 700597 = Hospital System Supply Identifier | 723733 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 24MM","code_information":[{"code":"Sx00-101-58-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700598","type":"LOCAL"},{"code":"723734","type":"LOCAL"}],"standard_charges":[{"gross_charge":377.35,"discounted_cash":132.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 700598 = Hospital System Supply Identifier | 723734 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 24MM","code_information":[{"code":"Sx00-101-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700599","type":"LOCAL"},{"code":"723735","type":"LOCAL"}],"standard_charges":[{"gross_charge":377.35,"discounted_cash":132.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 700599 = Hospital System Supply Identifier | 723735 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356749","type":"LOCAL"},{"code":"1083608","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356749 = Hospital System Supply Identifier | 1083608 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356990","type":"LOCAL"},{"code":"1083538","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356990 = Hospital System Supply Identifier | 1083538 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356711","type":"LOCAL"},{"code":"1083690","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356711 = Hospital System Supply Identifier | 1083690 = Lawson ID"}]},{"description":"PLATE-O DELTA 16MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899729","type":"LOCAL"},{"code":"593216","type":"LOCAL"}],"standard_charges":[{"gross_charge":3491.85,"discounted_cash":1222.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 899729 = Hospital System Supply Identifier | 593216 = Lawson ID"}]},{"description":"PLATE DELTA 12MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054296","type":"LOCAL"},{"code":"876746","type":"LOCAL"}],"standard_charges":[{"gross_charge":3491.85,"discounted_cash":1222.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054296 = Hospital System Supply Identifier | 876746 = Lawson ID"}]},{"description":"PLATE-O DELTA 24MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899728","type":"LOCAL"},{"code":"593215","type":"LOCAL"}],"standard_charges":[{"gross_charge":3491.85,"discounted_cash":1222.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 899728 = Hospital System Supply Identifier | 593215 = Lawson ID"}]},{"description":"PLATE DELTA 20MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054297","type":"LOCAL"},{"code":"876747","type":"LOCAL"}],"standard_charges":[{"gross_charge":3491.85,"discounted_cash":1222.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054297 = Hospital System Supply Identifier | 876747 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 12MM","code_information":[{"code":"Sx00-1012-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833246","type":"LOCAL"},{"code":"S366146","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833246 = Hospital System Supply Identifier | S366146 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 16MM","code_information":[{"code":"Sx00-1012-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"786764","type":"LOCAL"},{"code":"410073","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 786764 = Hospital System Supply Identifier | 410073 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 20MM","code_information":[{"code":"Sx00-1012-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"786763","type":"LOCAL"},{"code":"410074","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 786763 = Hospital System Supply Identifier | 410074 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 24MM","code_information":[{"code":"Sx00-1012-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833244","type":"LOCAL"},{"code":"S121116","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833244 = Hospital System Supply Identifier | S121116 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X16MM","code_information":[{"code":"Sx00-1015-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899731","type":"LOCAL"},{"code":"593218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1748.46,"discounted_cash":611.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 899731 = Hospital System Supply Identifier | 593218 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X24MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899730","type":"LOCAL"},{"code":"593217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1748.46,"discounted_cash":611.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 899730 = Hospital System Supply Identifier | 593217 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X20MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"899732","type":"LOCAL"},{"code":"593219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1748.46,"discounted_cash":611.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 899732 = Hospital System Supply Identifier | 593219 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X28MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054298","type":"LOCAL"},{"code":"876748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1748.46,"discounted_cash":611.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054298 = Hospital System Supply Identifier | 876748 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X32MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054299","type":"LOCAL"},{"code":"876749","type":"LOCAL"}],"standard_charges":[{"gross_charge":1748.46,"discounted_cash":611.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054299 = Hospital System Supply Identifier | 876749 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X36MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054300","type":"LOCAL"},{"code":"876750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1748.46,"discounted_cash":611.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054300 = Hospital System Supply Identifier | 876750 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X12MM","code_information":[{"code":"Sx00-1015-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063351","type":"LOCAL"},{"code":"418940","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1063351 = Hospital System Supply Identifier | 418940 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL SELF-TAPPING FT FOR-LAT","code_information":[{"code":"Sx00-1015-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356483","type":"LOCAL"},{"code":"1083673","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356483 = Hospital System Supply Identifier | 1083673 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X16MM","code_information":[{"code":"Sx00-1015-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063321","type":"LOCAL"},{"code":"399815","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1063321 = Hospital System Supply Identifier | 399815 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X18MM","code_information":[{"code":"Sx00-1015-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063352","type":"LOCAL"},{"code":"418942","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1063352 = Hospital System Supply Identifier | 418942 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X24MM","code_information":[{"code":"Sx00-1015-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063322","type":"LOCAL"},{"code":"399817","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1063322 = Hospital System Supply Identifier | 399817 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X26MM","code_information":[{"code":"Sx00-1015-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1063353","type":"LOCAL"},{"code":"418944","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1063353 = Hospital System Supply Identifier | 418944 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL ST","code_information":[{"code":"Sx00-1015-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356841","type":"LOCAL"},{"code":"1083629","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356841 = Hospital System Supply Identifier | 1083629 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT DIST FEM","code_information":[{"code":"Sx00-1015-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356633","type":"LOCAL"},{"code":"1083563","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356633 = Hospital System Supply Identifier | 1083563 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT LAT DIST FEM","code_information":[{"code":"Sx00-1015-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357108","type":"LOCAL"},{"code":"1083682","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357108 = Hospital System Supply Identifier | 1083682 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356484","type":"LOCAL"},{"code":"1083676","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356484 = Hospital System Supply Identifier | 1083676 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357258","type":"LOCAL"},{"code":"1083560","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357258 = Hospital System Supply Identifier | 1083560 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356968","type":"LOCAL"},{"code":"1083601","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356968 = Hospital System Supply Identifier | 1083601 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356878","type":"LOCAL"},{"code":"1083646","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356878 = Hospital System Supply Identifier | 1083646 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356502","type":"LOCAL"},{"code":"1083652","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356502 = Hospital System Supply Identifier | 1083652 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356755","type":"LOCAL"},{"code":"1083606","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356755 = Hospital System Supply Identifier | 1083606 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357234","type":"LOCAL"},{"code":"1083678","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357234 = Hospital System Supply Identifier | 1083678 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356754","type":"LOCAL"},{"code":"1083567","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356754 = Hospital System Supply Identifier | 1083567 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357260","type":"LOCAL"},{"code":"1083541","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357260 = Hospital System Supply Identifier | 1083541 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X16MM","code_information":[{"code":"Sx00-1015-316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050834","type":"LOCAL"},{"code":"405712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050834 = Hospital System Supply Identifier | 405712 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5","code_information":[{"code":"Sx00-1015-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051019","type":"LOCAL"},{"code":"424925","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1051019 = Hospital System Supply Identifier | 424925 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X24MM","code_information":[{"code":"Sx00-1015-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050835","type":"LOCAL"},{"code":"405713","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050835 = Hospital System Supply Identifier | 405713 = Lawson ID"}]},{"description":"SCREW CANN 4.5X28MM","code_information":[{"code":"Sx00-1015-328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054301","type":"LOCAL"},{"code":"876751","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054301 = Hospital System Supply Identifier | 876751 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X32MM","code_information":[{"code":"Sx00-1015-332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821527","type":"LOCAL"},{"code":"S281320","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821527 = Hospital System Supply Identifier | S281320 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X36MM","code_information":[{"code":"Sx00-1015-336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050836","type":"LOCAL"},{"code":"405715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050836 = Hospital System Supply Identifier | 405715 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 16MM","code_information":[{"code":"Sx00-1015-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833247","type":"LOCAL"},{"code":"S379497","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833247 = Hospital System Supply Identifier | S379497 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 22MM","code_information":[{"code":"Sx00-1015-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833245","type":"LOCAL"},{"code":"S287226","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833245 = Hospital System Supply Identifier | S287226 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 32MM","code_information":[{"code":"Sx00-1015-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050837","type":"LOCAL"},{"code":"410078","type":"LOCAL"}],"standard_charges":[{"gross_charge":2822.6,"discounted_cash":987.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050837 = Hospital System Supply Identifier | 410078 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X16MM","code_information":[{"code":"Sx00-1015-516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054302","type":"LOCAL"},{"code":"876752","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054302 = Hospital System Supply Identifier | 876752 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X20MM","code_information":[{"code":"Sx00-1015-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054303","type":"LOCAL"},{"code":"876753","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054303 = Hospital System Supply Identifier | 876753 = Lawson ID"}]},{"description":"SCREW BONE 244.5PEDIATRIC CANC","code_information":[{"code":"Sx00-1015-524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939746","type":"LOCAL"},{"code":"824274","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939746 = Hospital System Supply Identifier | 824274 = Lawson ID"}]},{"description":"SCREW BONE 284.5SELF TAP LOW P","code_information":[{"code":"Sx00-1015-528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939745","type":"LOCAL"},{"code":"824273","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939745 = Hospital System Supply Identifier | 824273 = Lawson ID"}]},{"description":"SCREW BONE 324.5LOW PROFILE SO","code_information":[{"code":"Sx00-1015-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939744","type":"LOCAL"},{"code":"824272","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939744 = Hospital System Supply Identifier | 824272 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X36MM","code_information":[{"code":"Sx00-1015-536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054304","type":"LOCAL"},{"code":"876754","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054304 = Hospital System Supply Identifier | 876754 = Lawson ID"}]},{"description":"SCREW BONE 164.5CANN LOW PROFI","code_information":[{"code":"Sx00-1015-616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"942930","type":"LOCAL"},{"code":"827490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 942930 = Hospital System Supply Identifier | 827490 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X20MM","code_information":[{"code":"Sx00-1015-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"802570","type":"LOCAL"},{"code":"S366668","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 802570 = Hospital System Supply Identifier | S366668 = Lawson ID"}]},{"description":"SCREW CANN LP 4.5X24MM","code_information":[{"code":"Sx00-1015-624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"892141","type":"LOCAL"},{"code":"536297","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 892141 = Hospital System Supply Identifier | 536297 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X28MM","code_information":[{"code":"Sx00-1015-628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"887630","type":"LOCAL"},{"code":"461781","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 887630 = Hospital System Supply Identifier | 461781 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X32MM","code_information":[{"code":"Sx00-1015-632","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"835986","type":"LOCAL"},{"code":"461782","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 835986 = Hospital System Supply Identifier | 461782 = Lawson ID"}]},{"description":"SCREW BONE 364.5FEMORAL PHYSEA","code_information":[{"code":"Sx00-1015-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"939471","type":"LOCAL"},{"code":"823995","type":"LOCAL"}],"standard_charges":[{"gross_charge":1408.86,"discounted_cash":493.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 939471 = Hospital System Supply Identifier | 823995 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054305","type":"LOCAL"},{"code":"876755","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054305 = Hospital System Supply Identifier | 876755 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054306","type":"LOCAL"},{"code":"876756","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054306 = Hospital System Supply Identifier | 876756 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054307","type":"LOCAL"},{"code":"876757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054307 = Hospital System Supply Identifier | 876757 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054308","type":"LOCAL"},{"code":"876758","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054308 = Hospital System Supply Identifier | 876758 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054310","type":"LOCAL"},{"code":"876760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054310 = Hospital System Supply Identifier | 876760 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054309","type":"LOCAL"},{"code":"876759","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054309 = Hospital System Supply Identifier | 876759 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054311","type":"LOCAL"},{"code":"876761","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054311 = Hospital System Supply Identifier | 876761 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054312","type":"LOCAL"},{"code":"876762","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054312 = Hospital System Supply Identifier | 876762 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054313","type":"LOCAL"},{"code":"876763","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054313 = Hospital System Supply Identifier | 876763 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054314","type":"LOCAL"},{"code":"876764","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054314 = Hospital System Supply Identifier | 876764 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054315","type":"LOCAL"},{"code":"876765","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054315 = Hospital System Supply Identifier | 876765 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054316","type":"LOCAL"},{"code":"876766","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.75,"discounted_cash":355.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054316 = Hospital System Supply Identifier | 876766 = Lawson ID"}]},{"description":"O-PLATE TI 12MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054317","type":"LOCAL"},{"code":"876767","type":"LOCAL"}],"standard_charges":[{"gross_charge":3686.4,"discounted_cash":1290.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054317 = Hospital System Supply Identifier | 876767 = Lawson ID"}]},{"description":"O-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054318","type":"LOCAL"},{"code":"876768","type":"LOCAL"}],"standard_charges":[{"gross_charge":3686.4,"discounted_cash":1290.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054318 = Hospital System Supply Identifier | 876768 = Lawson ID"}]},{"description":"O-PLATE TI 24MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054320","type":"LOCAL"},{"code":"876770","type":"LOCAL"}],"standard_charges":[{"gross_charge":3686.4,"discounted_cash":1290.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054320 = Hospital System Supply Identifier | 876770 = Lawson ID"}]},{"description":"O-PLATE TI 20MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054319","type":"LOCAL"},{"code":"876769","type":"LOCAL"}],"standard_charges":[{"gross_charge":3686.4,"discounted_cash":1290.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054319 = Hospital System Supply Identifier | 876769 = Lawson ID"}]},{"description":"I-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054321","type":"LOCAL"},{"code":"876771","type":"LOCAL"}],"standard_charges":[{"gross_charge":3686.4,"discounted_cash":1290.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054321 = Hospital System Supply Identifier | 876771 = Lawson ID"}]},{"description":"I-PLATE TI 22MM","code_information":[{"code":"Sx00-1015-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054322","type":"LOCAL"},{"code":"876772","type":"LOCAL"}],"standard_charges":[{"gross_charge":3686.4,"discounted_cash":1290.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054322 = Hospital System Supply Identifier | 876772 = Lawson ID"}]},{"description":"I-PLATE TI 32MM","code_information":[{"code":"Sx00-1015-843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054323","type":"LOCAL"},{"code":"876773","type":"LOCAL"}],"standard_charges":[{"gross_charge":3686.4,"discounted_cash":1290.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054323 = Hospital System Supply Identifier | 876773 = Lawson ID"}]},{"description":"WASHER","code_information":[{"code":"Sx00-1030-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054324","type":"LOCAL"},{"code":"876774","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054324 = Hospital System Supply Identifier | 876774 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054325","type":"LOCAL"},{"code":"876775","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054325 = Hospital System Supply Identifier | 876775 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054326","type":"LOCAL"},{"code":"876776","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054326 = Hospital System Supply Identifier | 876776 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054327","type":"LOCAL"},{"code":"876777","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054327 = Hospital System Supply Identifier | 876777 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054328","type":"LOCAL"},{"code":"876778","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054328 = Hospital System Supply Identifier | 876778 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054329","type":"LOCAL"},{"code":"876779","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054329 = Hospital System Supply Identifier | 876779 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054330","type":"LOCAL"},{"code":"876780","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054330 = Hospital System Supply Identifier | 876780 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054331","type":"LOCAL"},{"code":"876781","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054331 = Hospital System Supply Identifier | 876781 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054332","type":"LOCAL"},{"code":"876782","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054332 = Hospital System Supply Identifier | 876782 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054333","type":"LOCAL"},{"code":"876783","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054333 = Hospital System Supply Identifier | 876783 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054334","type":"LOCAL"},{"code":"876784","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054334 = Hospital System Supply Identifier | 876784 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054335","type":"LOCAL"},{"code":"876785","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054335 = Hospital System Supply Identifier | 876785 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054336","type":"LOCAL"},{"code":"876786","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054336 = Hospital System Supply Identifier | 876786 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054337","type":"LOCAL"},{"code":"876787","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054337 = Hospital System Supply Identifier | 876787 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054338","type":"LOCAL"},{"code":"876788","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054338 = Hospital System Supply Identifier | 876788 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054339","type":"LOCAL"},{"code":"876789","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054339 = Hospital System Supply Identifier | 876789 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054340","type":"LOCAL"},{"code":"876790","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054340 = Hospital System Supply Identifier | 876790 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054341","type":"LOCAL"},{"code":"876791","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054341 = Hospital System Supply Identifier | 876791 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054342","type":"LOCAL"},{"code":"876792","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054342 = Hospital System Supply Identifier | 876792 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054343","type":"LOCAL"},{"code":"876793","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054343 = Hospital System Supply Identifier | 876793 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054344","type":"LOCAL"},{"code":"876794","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054344 = Hospital System Supply Identifier | 876794 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054345","type":"LOCAL"},{"code":"876795","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054345 = Hospital System Supply Identifier | 876795 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054346","type":"LOCAL"},{"code":"876796","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054346 = Hospital System Supply Identifier | 876796 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054347","type":"LOCAL"},{"code":"876797","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054347 = Hospital System Supply Identifier | 876797 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054348","type":"LOCAL"},{"code":"876798","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054348 = Hospital System Supply Identifier | 876798 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X35MM","code_information":[{"code":"Sx00-1030-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054349","type":"LOCAL"},{"code":"876799","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054349 = Hospital System Supply Identifier | 876799 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054350","type":"LOCAL"},{"code":"876800","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054350 = Hospital System Supply Identifier | 876800 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X45MM","code_information":[{"code":"Sx00-1030-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054351","type":"LOCAL"},{"code":"876801","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054351 = Hospital System Supply Identifier | 876801 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054352","type":"LOCAL"},{"code":"876802","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054352 = Hospital System Supply Identifier | 876802 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X55MM","code_information":[{"code":"Sx00-1030-155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054353","type":"LOCAL"},{"code":"876803","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054353 = Hospital System Supply Identifier | 876803 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054354","type":"LOCAL"},{"code":"876804","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054354 = Hospital System Supply Identifier | 876804 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054355","type":"LOCAL"},{"code":"876805","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054355 = Hospital System Supply Identifier | 876805 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054356","type":"LOCAL"},{"code":"876806","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054356 = Hospital System Supply Identifier | 876806 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X10MM","code_information":[{"code":"Sx00-1030-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054357","type":"LOCAL"},{"code":"876807","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054357 = Hospital System Supply Identifier | 876807 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X12MM","code_information":[{"code":"Sx00-1030-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054358","type":"LOCAL"},{"code":"876808","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054358 = Hospital System Supply Identifier | 876808 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X14MM","code_information":[{"code":"Sx00-1030-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054359","type":"LOCAL"},{"code":"876809","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054359 = Hospital System Supply Identifier | 876809 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X16MM","code_information":[{"code":"Sx00-1030-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054360","type":"LOCAL"},{"code":"876810","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054360 = Hospital System Supply Identifier | 876810 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X18MM","code_information":[{"code":"Sx00-1030-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054361","type":"LOCAL"},{"code":"876811","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054361 = Hospital System Supply Identifier | 876811 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054362","type":"LOCAL"},{"code":"876812","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054362 = Hospital System Supply Identifier | 876812 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054363","type":"LOCAL"},{"code":"876813","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054363 = Hospital System Supply Identifier | 876813 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054364","type":"LOCAL"},{"code":"876814","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054364 = Hospital System Supply Identifier | 876814 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054365","type":"LOCAL"},{"code":"876815","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054365 = Hospital System Supply Identifier | 876815 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054366","type":"LOCAL"},{"code":"876816","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054366 = Hospital System Supply Identifier | 876816 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054367","type":"LOCAL"},{"code":"876817","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054367 = Hospital System Supply Identifier | 876817 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054368","type":"LOCAL"},{"code":"876818","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054368 = Hospital System Supply Identifier | 876818 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054369","type":"LOCAL"},{"code":"876819","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054369 = Hospital System Supply Identifier | 876819 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054370","type":"LOCAL"},{"code":"876820","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054370 = Hospital System Supply Identifier | 876820 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054371","type":"LOCAL"},{"code":"876821","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054371 = Hospital System Supply Identifier | 876821 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054372","type":"LOCAL"},{"code":"876822","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054372 = Hospital System Supply Identifier | 876822 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054373","type":"LOCAL"},{"code":"876823","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054373 = Hospital System Supply Identifier | 876823 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054374","type":"LOCAL"},{"code":"876824","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054374 = Hospital System Supply Identifier | 876824 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054375","type":"LOCAL"},{"code":"876825","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054375 = Hospital System Supply Identifier | 876825 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054376","type":"LOCAL"},{"code":"876826","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054376 = Hospital System Supply Identifier | 876826 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054377","type":"LOCAL"},{"code":"876827","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054377 = Hospital System Supply Identifier | 876827 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054378","type":"LOCAL"},{"code":"876828","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054378 = Hospital System Supply Identifier | 876828 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054379","type":"LOCAL"},{"code":"876829","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054379 = Hospital System Supply Identifier | 876829 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054380","type":"LOCAL"},{"code":"876830","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054380 = Hospital System Supply Identifier | 876830 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054381","type":"LOCAL"},{"code":"876831","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054381 = Hospital System Supply Identifier | 876831 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054382","type":"LOCAL"},{"code":"876832","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054382 = Hospital System Supply Identifier | 876832 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054383","type":"LOCAL"},{"code":"876833","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054383 = Hospital System Supply Identifier | 876833 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054384","type":"LOCAL"},{"code":"876834","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054384 = Hospital System Supply Identifier | 876834 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 03MM","code_information":[{"code":"Sx00-104-19-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"92839","type":"LOCAL"},{"code":"144792","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 92839 = Hospital System Supply Identifier | 144792 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 05MM","code_information":[{"code":"Sx00-104-20-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"205625","type":"LOCAL"},{"code":"144793","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 205625 = Hospital System Supply Identifier | 144793 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 07MM","code_information":[{"code":"Sx00-104-21-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"205626","type":"LOCAL"},{"code":"144794","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 205626 = Hospital System Supply Identifier | 144794 = Lawson ID"}]},{"description":"PLATE CHIN GRIFFIN 9MM ADV","code_information":[{"code":"Sx00-104-22-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"192176","type":"LOCAL"},{"code":"232039","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 192176 = Hospital System Supply Identifier | 232039 = Lawson ID"}]},{"description":"PLATE LVL1 ORTHOG GRIFFIN","code_information":[{"code":"Sx00-104-23-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700425","type":"LOCAL"},{"code":"723561","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 700425 = Hospital System Supply Identifier | 723561 = Lawson ID"}]},{"description":"DRILL TWIST MIDAS REX 1.0 X5MM","code_information":[{"code":"Sx00-104-49-0","type":"CDM"},{"code":"272","type":"RC"},{"code":"157623","type":"LOCAL"},{"code":"310249","type":"LOCAL"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 157623 = Hospital System Supply Identifier | 310249 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-105-49-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"779932","type":"LOCAL"},{"code":"773377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1969.06,"discounted_cash":689.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 779932 = Hospital System Supply Identifier | 773377 = Lawson ID"}]},{"description":"PLATE LVL1 MINI BAYS T-SHP 4HL","code_information":[{"code":"Sx00-105-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"700557","type":"LOCAL"},{"code":"723693","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.75,"discounted_cash":222.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 700557 = Hospital System Supply Identifier | 723693 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 8H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050849","type":"LOCAL"},{"code":"414030","type":"LOCAL"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050849 = Hospital System Supply Identifier | 414030 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 7H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050848","type":"LOCAL"},{"code":"414029","type":"LOCAL"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050848 = Hospital System Supply Identifier | 414029 = Lawson ID"}]},{"description":"PLATE LOK TBLR 1/3 6H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050838","type":"LOCAL"},{"code":"410079","type":"LOCAL"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050838 = Hospital System Supply Identifier | 410079 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 4H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050846","type":"LOCAL"},{"code":"414027","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050846 = Hospital System Supply Identifier | 414027 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 5H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050847","type":"LOCAL"},{"code":"414028","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050847 = Hospital System Supply Identifier | 414028 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 10H","code_information":[{"code":"Sx00-1050-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050850","type":"LOCAL"},{"code":"414031","type":"LOCAL"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":271.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050850 = Hospital System Supply Identifier | 414031 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 4H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050851","type":"LOCAL"},{"code":"414032","type":"LOCAL"}],"standard_charges":[{"gross_charge":1485.0,"discounted_cash":519.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050851 = Hospital System Supply Identifier | 414032 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 6H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050852","type":"LOCAL"},{"code":"414033","type":"LOCAL"}],"standard_charges":[{"gross_charge":1608.75,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050852 = Hospital System Supply Identifier | 414033 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 8H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050853","type":"LOCAL"},{"code":"414034","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":600.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050853 = Hospital System Supply Identifier | 414034 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 10H","code_information":[{"code":"Sx00-1050-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050854","type":"LOCAL"},{"code":"414035","type":"LOCAL"}],"standard_charges":[{"gross_charge":1837.5,"discounted_cash":643.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050854 = Hospital System Supply Identifier | 414035 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 8H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833243","type":"LOCAL"},{"code":"S392027","type":"LOCAL"}],"standard_charges":[{"gross_charge":13883.54,"discounted_cash":4859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833243 = Hospital System Supply Identifier | S392027 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 6H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051006","type":"LOCAL"},{"code":"414193","type":"LOCAL"}],"standard_charges":[{"gross_charge":13883.54,"discounted_cash":4859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1051006 = Hospital System Supply Identifier | 414193 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING FEMORAL TITANIUM 18-HOLE","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357259","type":"LOCAL"},{"code":"1083572","type":"LOCAL"}],"standard_charges":[{"gross_charge":16885.5,"discounted_cash":5909.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357259 = Hospital System Supply Identifier | 1083572 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050855","type":"LOCAL"},{"code":"414036","type":"LOCAL"}],"standard_charges":[{"gross_charge":14221.92,"discounted_cash":4977.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050855 = Hospital System Supply Identifier | 414036 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050856","type":"LOCAL"},{"code":"414037","type":"LOCAL"}],"standard_charges":[{"gross_charge":14535.05,"discounted_cash":5087.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050856 = Hospital System Supply Identifier | 414037 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050857","type":"LOCAL"},{"code":"414038","type":"LOCAL"}],"standard_charges":[{"gross_charge":16885.5,"discounted_cash":5909.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050857 = Hospital System Supply Identifier | 414038 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 10H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"819438","type":"LOCAL"},{"code":"S282456","type":"LOCAL"}],"standard_charges":[{"gross_charge":13908.8,"discounted_cash":4868.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 819438 = Hospital System Supply Identifier | S282456 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 6H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050839","type":"LOCAL"},{"code":"410081","type":"LOCAL"}],"standard_charges":[{"gross_charge":13883.54,"discounted_cash":4859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050839 = Hospital System Supply Identifier | 410081 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 8H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050840","type":"LOCAL"},{"code":"410082","type":"LOCAL"}],"standard_charges":[{"gross_charge":13883.54,"discounted_cash":4859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050840 = Hospital System Supply Identifier | 410082 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050860","type":"LOCAL"},{"code":"414042","type":"LOCAL"}],"standard_charges":[{"gross_charge":14535.05,"discounted_cash":5087.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050860 = Hospital System Supply Identifier | 414042 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050859","type":"LOCAL"},{"code":"414041","type":"LOCAL"}],"standard_charges":[{"gross_charge":14221.92,"discounted_cash":4977.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050859 = Hospital System Supply Identifier | 414041 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050861","type":"LOCAL"},{"code":"414043","type":"LOCAL"}],"standard_charges":[{"gross_charge":16885.5,"discounted_cash":5909.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050861 = Hospital System Supply Identifier | 414043 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION LOCKING 18 HOLE PEDILOC 0010503118 3.5MM","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356461","type":"LOCAL"},{"code":"1083743","type":"LOCAL"}],"standard_charges":[{"gross_charge":16885.5,"discounted_cash":5909.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356461 = Hospital System Supply Identifier | 1083743 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 10H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050858","type":"LOCAL"},{"code":"414040","type":"LOCAL"}],"standard_charges":[{"gross_charge":13908.8,"discounted_cash":4868.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050858 = Hospital System Supply Identifier | 414040 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 14H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050841","type":"LOCAL"},{"code":"410083","type":"LOCAL"}],"standard_charges":[{"gross_charge":10681.77,"discounted_cash":3738.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050841 = Hospital System Supply Identifier | 410083 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 10H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050862","type":"LOCAL"},{"code":"414045","type":"LOCAL"}],"standard_charges":[{"gross_charge":9651.92,"discounted_cash":3378.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050862 = Hospital System Supply Identifier | 414045 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 12H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050863","type":"LOCAL"},{"code":"414046","type":"LOCAL"}],"standard_charges":[{"gross_charge":9916.95,"discounted_cash":3470.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050863 = Hospital System Supply Identifier | 414046 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 16H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050864","type":"LOCAL"},{"code":"414047","type":"LOCAL"}],"standard_charges":[{"gross_charge":12426.22,"discounted_cash":4349.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050864 = Hospital System Supply Identifier | 414047 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 18H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050865","type":"LOCAL"},{"code":"414048","type":"LOCAL"}],"standard_charges":[{"gross_charge":12827.07,"discounted_cash":4489.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050865 = Hospital System Supply Identifier | 414048 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 8H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050870","type":"LOCAL"},{"code":"414053","type":"LOCAL"}],"standard_charges":[{"gross_charge":539.3,"discounted_cash":188.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050870 = Hospital System Supply Identifier | 414053 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 6H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050868","type":"LOCAL"},{"code":"414051","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.9,"discounted_cash":181.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050868 = Hospital System Supply Identifier | 414051 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 7H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050869","type":"LOCAL"},{"code":"414052","type":"LOCAL"}],"standard_charges":[{"gross_charge":539.3,"discounted_cash":188.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050869 = Hospital System Supply Identifier | 414052 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 4H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050866","type":"LOCAL"},{"code":"414049","type":"LOCAL"}],"standard_charges":[{"gross_charge":496.5,"discounted_cash":173.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050866 = Hospital System Supply Identifier | 414049 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 5H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050867","type":"LOCAL"},{"code":"414050","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.9,"discounted_cash":181.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050867 = Hospital System Supply Identifier | 414050 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 10H","code_information":[{"code":"Sx00-1050-341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050871","type":"LOCAL"},{"code":"414054","type":"LOCAL"}],"standard_charges":[{"gross_charge":614.85,"discounted_cash":215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050871 = Hospital System Supply Identifier | 414054 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X14","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050874","type":"LOCAL"},{"code":"414057","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050874 = Hospital System Supply Identifier | 414057 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X16","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050832","type":"LOCAL"},{"code":"402528","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050832 = Hospital System Supply Identifier | 402528 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X18","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050833","type":"LOCAL"},{"code":"402529","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050833 = Hospital System Supply Identifier | 402529 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X10","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050872","type":"LOCAL"},{"code":"414055","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050872 = Hospital System Supply Identifier | 414055 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X12","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050873","type":"LOCAL"},{"code":"414056","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050873 = Hospital System Supply Identifier | 414056 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X28","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050719","type":"LOCAL"},{"code":"399824","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050719 = Hospital System Supply Identifier | 399824 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X26","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821174","type":"LOCAL"},{"code":"S282468","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821174 = Hospital System Supply Identifier | S282468 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X22","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050717","type":"LOCAL"},{"code":"399821","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050717 = Hospital System Supply Identifier | 399821 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X24","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050718","type":"LOCAL"},{"code":"399822","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050718 = Hospital System Supply Identifier | 399822 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X20","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821159","type":"LOCAL"},{"code":"S282457","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821159 = Hospital System Supply Identifier | S282457 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X36","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050720","type":"LOCAL"},{"code":"399828","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050720 = Hospital System Supply Identifier | 399828 = Lawson ID"}]},{"description":"SCREW CORT NLOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1051020","type":"LOCAL"},{"code":"431449","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1051020 = Hospital System Supply Identifier | 431449 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X30","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833236","type":"LOCAL"},{"code":"S392020","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833236 = Hospital System Supply Identifier | S392020 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X32","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833237","type":"LOCAL"},{"code":"S392021","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833237 = Hospital System Supply Identifier | S392021 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X34","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833238","type":"LOCAL"},{"code":"S392022","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833238 = Hospital System Supply Identifier | S392022 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X42","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050876","type":"LOCAL"},{"code":"414059","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050876 = Hospital System Supply Identifier | 414059 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X46","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833239","type":"LOCAL"},{"code":"S392023","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833239 = Hospital System Supply Identifier | S392023 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X48","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050721","type":"LOCAL"},{"code":"399829","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050721 = Hospital System Supply Identifier | 399829 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X40","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050875","type":"LOCAL"},{"code":"414058","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050875 = Hospital System Supply Identifier | 414058 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X44","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050877","type":"LOCAL"},{"code":"414060","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050877 = Hospital System Supply Identifier | 414060 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X50","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050878","type":"LOCAL"},{"code":"414062","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050878 = Hospital System Supply Identifier | 414062 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X52","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050879","type":"LOCAL"},{"code":"414063","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050879 = Hospital System Supply Identifier | 414063 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X54","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050880","type":"LOCAL"},{"code":"414064","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050880 = Hospital System Supply Identifier | 414064 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X56","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050881","type":"LOCAL"},{"code":"414065","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050881 = Hospital System Supply Identifier | 414065 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X58","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050882","type":"LOCAL"},{"code":"414066","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050882 = Hospital System Supply Identifier | 414066 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X60","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833240","type":"LOCAL"},{"code":"S392024","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833240 = Hospital System Supply Identifier | S392024 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X65","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833241","type":"LOCAL"},{"code":"S392025","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833241 = Hospital System Supply Identifier | S392025 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X70","code_information":[{"code":"Sx00-1050-357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050883","type":"LOCAL"},{"code":"414069","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050883 = Hospital System Supply Identifier | 414069 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X10MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050884","type":"LOCAL"},{"code":"414070","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050884 = Hospital System Supply Identifier | 414070 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X14MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050885","type":"LOCAL"},{"code":"414071","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050885 = Hospital System Supply Identifier | 414071 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X16MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"880906","type":"LOCAL"},{"code":"399831","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 880906 = Hospital System Supply Identifier | 399831 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X12MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050722","type":"LOCAL"},{"code":"399830","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050722 = Hospital System Supply Identifier | 399830 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X18MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050723","type":"LOCAL"},{"code":"399832","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050723 = Hospital System Supply Identifier | 399832 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X20MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050724","type":"LOCAL"},{"code":"399833","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050724 = Hospital System Supply Identifier | 399833 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X24MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050725","type":"LOCAL"},{"code":"399835","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050725 = Hospital System Supply Identifier | 399835 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X26MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050726","type":"LOCAL"},{"code":"399836","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050726 = Hospital System Supply Identifier | 399836 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X22MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821164","type":"LOCAL"},{"code":"S282459","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821164 = Hospital System Supply Identifier | S282459 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X28MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821181","type":"LOCAL"},{"code":"S282460","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821181 = Hospital System Supply Identifier | S282460 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X30MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"821186","type":"LOCAL"},{"code":"S282461","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 821186 = Hospital System Supply Identifier | S282461 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050886","type":"LOCAL"},{"code":"414072","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050886 = Hospital System Supply Identifier | 414072 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X36MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050729","type":"LOCAL"},{"code":"399841","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050729 = Hospital System Supply Identifier | 399841 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X32MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050727","type":"LOCAL"},{"code":"399839","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050727 = Hospital System Supply Identifier | 399839 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X34MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050728","type":"LOCAL"},{"code":"399840","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050728 = Hospital System Supply Identifier | 399840 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X40MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050730","type":"LOCAL"},{"code":"399842","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050730 = Hospital System Supply Identifier | 399842 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X42MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050731","type":"LOCAL"},{"code":"399843","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050731 = Hospital System Supply Identifier | 399843 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X44MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050732","type":"LOCAL"},{"code":"399844","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050732 = Hospital System Supply Identifier | 399844 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X46MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050733","type":"LOCAL"},{"code":"399845","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050733 = Hospital System Supply Identifier | 399845 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X48MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050734","type":"LOCAL"},{"code":"399846","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050734 = Hospital System Supply Identifier | 399846 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X54MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"833242","type":"LOCAL"},{"code":"S392026","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 833242 = Hospital System Supply Identifier | S392026 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X50MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050887","type":"LOCAL"},{"code":"414073","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050887 = Hospital System Supply Identifier | 414073 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X56MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050888","type":"LOCAL"},{"code":"414075","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050888 = Hospital System Supply Identifier | 414075 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X52MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050735","type":"LOCAL"},{"code":"399847","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050735 = Hospital System Supply Identifier | 399847 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X58MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050736","type":"LOCAL"},{"code":"399848","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050736 = Hospital System Supply Identifier | 399848 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X60MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050889","type":"LOCAL"},{"code":"414076","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050889 = Hospital System Supply Identifier | 414076 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X65MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050890","type":"LOCAL"},{"code":"414077","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050890 = Hospital System Supply Identifier | 414077 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X70MM","code_information":[{"code":"Sx00-1050-367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050891","type":"LOCAL"},{"code":"414078","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050891 = Hospital System Supply Identifier | 414078 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X10","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050892","type":"LOCAL"},{"code":"414079","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050892 = Hospital System Supply Identifier | 414079 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X12","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050893","type":"LOCAL"},{"code":"414080","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050893 = Hospital System Supply Identifier | 414080 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X14","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050894","type":"LOCAL"},{"code":"414081","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050894 = Hospital System Supply Identifier | 414081 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X16","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050895","type":"LOCAL"},{"code":"414082","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050895 = Hospital System Supply Identifier | 414082 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X18","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050896","type":"LOCAL"},{"code":"414083","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050896 = Hospital System Supply Identifier | 414083 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X28","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050901","type":"LOCAL"},{"code":"414088","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050901 = Hospital System Supply Identifier | 414088 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X26","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050900","type":"LOCAL"},{"code":"414087","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050900 = Hospital System Supply Identifier | 414087 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X20","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050897","type":"LOCAL"},{"code":"414084","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050897 = Hospital System Supply Identifier | 414084 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X22","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050898","type":"LOCAL"},{"code":"414085","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050898 = Hospital System Supply Identifier | 414085 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X24","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050899","type":"LOCAL"},{"code":"414086","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050899 = Hospital System Supply Identifier | 414086 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X30","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050902","type":"LOCAL"},{"code":"414089","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050902 = Hospital System Supply Identifier | 414089 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X32","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050903","type":"LOCAL"},{"code":"414090","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050903 = Hospital System Supply Identifier | 414090 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X34","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050904","type":"LOCAL"},{"code":"414091","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050904 = Hospital System Supply Identifier | 414091 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X36","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050905","type":"LOCAL"},{"code":"414092","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050905 = Hospital System Supply Identifier | 414092 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X38","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050906","type":"LOCAL"},{"code":"414093","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050906 = Hospital System Supply Identifier | 414093 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X48","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050911","type":"LOCAL"},{"code":"414098","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050911 = Hospital System Supply Identifier | 414098 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X46","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050910","type":"LOCAL"},{"code":"414097","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050910 = Hospital System Supply Identifier | 414097 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X40","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050907","type":"LOCAL"},{"code":"414094","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050907 = Hospital System Supply Identifier | 414094 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X42","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050908","type":"LOCAL"},{"code":"414095","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050908 = Hospital System Supply Identifier | 414095 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X44","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050909","type":"LOCAL"},{"code":"414096","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050909 = Hospital System Supply Identifier | 414096 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X50","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050912","type":"LOCAL"},{"code":"414099","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050912 = Hospital System Supply Identifier | 414099 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X52","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050913","type":"LOCAL"},{"code":"414100","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050913 = Hospital System Supply Identifier | 414100 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X54","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050914","type":"LOCAL"},{"code":"414101","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050914 = Hospital System Supply Identifier | 414101 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X56","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050915","type":"LOCAL"},{"code":"414102","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050915 = Hospital System Supply Identifier | 414102 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X58","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050916","type":"LOCAL"},{"code":"414103","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050916 = Hospital System Supply Identifier | 414103 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X60","code_information":[{"code":"Sx00-1050-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050917","type":"LOCAL"},{"code":"414104","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050917 = Hospital System Supply Identifier | 414104 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X18","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050922","type":"LOCAL"},{"code":"414109","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050922 = Hospital System Supply Identifier | 414109 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X16","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050921","type":"LOCAL"},{"code":"414108","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050921 = Hospital System Supply Identifier | 414108 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X12","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050919","type":"LOCAL"},{"code":"414106","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050919 = Hospital System Supply Identifier | 414106 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X10","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050918","type":"LOCAL"},{"code":"414105","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050918 = Hospital System Supply Identifier | 414105 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X14","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050920","type":"LOCAL"},{"code":"414107","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050920 = Hospital System Supply Identifier | 414107 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X20","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050923","type":"LOCAL"},{"code":"414110","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050923 = Hospital System Supply Identifier | 414110 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X22","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050924","type":"LOCAL"},{"code":"414111","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050924 = Hospital System Supply Identifier | 414111 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X24","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050925","type":"LOCAL"},{"code":"414112","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050925 = Hospital System Supply Identifier | 414112 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X26","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050926","type":"LOCAL"},{"code":"414113","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050926 = Hospital System Supply Identifier | 414113 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X28","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050927","type":"LOCAL"},{"code":"414114","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050927 = Hospital System Supply Identifier | 414114 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X38","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050932","type":"LOCAL"},{"code":"414119","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050932 = Hospital System Supply Identifier | 414119 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X36","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050931","type":"LOCAL"},{"code":"414118","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050931 = Hospital System Supply Identifier | 414118 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X30","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050928","type":"LOCAL"},{"code":"414115","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050928 = Hospital System Supply Identifier | 414115 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X32","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050929","type":"LOCAL"},{"code":"414116","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050929 = Hospital System Supply Identifier | 414116 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X34","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050930","type":"LOCAL"},{"code":"414117","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050930 = Hospital System Supply Identifier | 414117 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X40","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050933","type":"LOCAL"},{"code":"414120","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050933 = Hospital System Supply Identifier | 414120 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X42","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050934","type":"LOCAL"},{"code":"414121","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050934 = Hospital System Supply Identifier | 414121 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X44","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050935","type":"LOCAL"},{"code":"414122","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050935 = Hospital System Supply Identifier | 414122 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X46","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050936","type":"LOCAL"},{"code":"414123","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050936 = Hospital System Supply Identifier | 414123 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X48","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050937","type":"LOCAL"},{"code":"414124","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050937 = Hospital System Supply Identifier | 414124 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X58","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050942","type":"LOCAL"},{"code":"414129","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050942 = Hospital System Supply Identifier | 414129 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X56","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050941","type":"LOCAL"},{"code":"414128","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050941 = Hospital System Supply Identifier | 414128 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X52","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050939","type":"LOCAL"},{"code":"414126","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050939 = Hospital System Supply Identifier | 414126 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X50","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050938","type":"LOCAL"},{"code":"414125","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050938 = Hospital System Supply Identifier | 414125 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X54","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050940","type":"LOCAL"},{"code":"414127","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050940 = Hospital System Supply Identifier | 414127 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X60","code_information":[{"code":"Sx00-1050-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050943","type":"LOCAL"},{"code":"414130","type":"LOCAL"}],"standard_charges":[{"gross_charge":126.25,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050943 = Hospital System Supply Identifier | 414130 = Lawson ID"}]},{"description":"PLATE PEDI COMP FEM 4.5MM 6H","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050842","type":"LOCAL"},{"code":"410084","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050842 = Hospital System Supply Identifier | 410084 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.52 8H RT","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050944","type":"LOCAL"},{"code":"414131","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050944 = Hospital System Supply Identifier | 414131 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 16H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050948","type":"LOCAL"},{"code":"414135","type":"LOCAL"}],"standard_charges":[{"gross_charge":18135.7,"discounted_cash":6347.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050948 = Hospital System Supply Identifier | 414135 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 14H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050947","type":"LOCAL"},{"code":"414134","type":"LOCAL"}],"standard_charges":[{"gross_charge":17767.21,"discounted_cash":6218.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050947 = Hospital System Supply Identifier | 414134 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050949","type":"LOCAL"},{"code":"414136","type":"LOCAL"}],"standard_charges":[{"gross_charge":19599.7,"discounted_cash":6859.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050949 = Hospital System Supply Identifier | 414136 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050945","type":"LOCAL"},{"code":"414132","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050945 = Hospital System Supply Identifier | 414132 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050946","type":"LOCAL"},{"code":"414133","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050946 = Hospital System Supply Identifier | 414133 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H RT","code_information":[{"code":"Sx00-1050-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050950","type":"LOCAL"},{"code":"414137","type":"LOCAL"}],"standard_charges":[{"gross_charge":20421.33,"discounted_cash":7147.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050950 = Hospital System Supply Identifier | 414137 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 6H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050951","type":"LOCAL"},{"code":"414138","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050951 = Hospital System Supply Identifier | 414138 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 8H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050952","type":"LOCAL"},{"code":"414139","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050952 = Hospital System Supply Identifier | 414139 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050843","type":"LOCAL"},{"code":"410085","type":"LOCAL"}],"standard_charges":[{"gross_charge":17767.21,"discounted_cash":6218.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050843 = Hospital System Supply Identifier | 410085 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050844","type":"LOCAL"},{"code":"410086","type":"LOCAL"}],"standard_charges":[{"gross_charge":18135.7,"discounted_cash":6347.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050844 = Hospital System Supply Identifier | 410086 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050953","type":"LOCAL"},{"code":"414140","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050953 = Hospital System Supply Identifier | 414140 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050954","type":"LOCAL"},{"code":"414141","type":"LOCAL"}],"standard_charges":[{"gross_charge":17373.82,"discounted_cash":6080.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050954 = Hospital System Supply Identifier | 414141 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050955","type":"LOCAL"},{"code":"414142","type":"LOCAL"}],"standard_charges":[{"gross_charge":19599.7,"discounted_cash":6859.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050955 = Hospital System Supply Identifier | 414142 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H LT","code_information":[{"code":"Sx00-1050-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050956","type":"LOCAL"},{"code":"414143","type":"LOCAL"}],"standard_charges":[{"gross_charge":20421.33,"discounted_cash":7147.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050956 = Hospital System Supply Identifier | 414143 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 18H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050960","type":"LOCAL"},{"code":"414147","type":"LOCAL"}],"standard_charges":[{"gross_charge":13141.14,"discounted_cash":4599.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050960 = Hospital System Supply Identifier | 414147 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050959","type":"LOCAL"},{"code":"414146","type":"LOCAL"}],"standard_charges":[{"gross_charge":12644.4,"discounted_cash":4425.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050959 = Hospital System Supply Identifier | 414146 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 10H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050845","type":"LOCAL"},{"code":"410087","type":"LOCAL"}],"standard_charges":[{"gross_charge":9916.95,"discounted_cash":3470.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050845 = Hospital System Supply Identifier | 410087 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 12H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050957","type":"LOCAL"},{"code":"414144","type":"LOCAL"}],"standard_charges":[{"gross_charge":10291.66,"discounted_cash":3602.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050957 = Hospital System Supply Identifier | 414144 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050958","type":"LOCAL"},{"code":"414145","type":"LOCAL"}],"standard_charges":[{"gross_charge":10751.8,"discounted_cash":3763.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050958 = Hospital System Supply Identifier | 414145 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X10","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050961","type":"LOCAL"},{"code":"414148","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050961 = Hospital System Supply Identifier | 414148 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X12","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050962","type":"LOCAL"},{"code":"414149","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050962 = Hospital System Supply Identifier | 414149 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X14","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050963","type":"LOCAL"},{"code":"414150","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050963 = Hospital System Supply Identifier | 414150 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X16","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050964","type":"LOCAL"},{"code":"414151","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050964 = Hospital System Supply Identifier | 414151 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X18","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050965","type":"LOCAL"},{"code":"414152","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050965 = Hospital System Supply Identifier | 414152 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X28","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050968","type":"LOCAL"},{"code":"414155","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050968 = Hospital System Supply Identifier | 414155 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X24","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050967","type":"LOCAL"},{"code":"414154","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050967 = Hospital System Supply Identifier | 414154 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X22","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050737","type":"LOCAL"},{"code":"399849","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050737 = Hospital System Supply Identifier | 399849 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X26","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050738","type":"LOCAL"},{"code":"399850","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050738 = Hospital System Supply Identifier | 399850 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X20","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050966","type":"LOCAL"},{"code":"414153","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050966 = Hospital System Supply Identifier | 414153 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X32","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050739","type":"LOCAL"},{"code":"399851","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050739 = Hospital System Supply Identifier | 399851 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X30","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050969","type":"LOCAL"},{"code":"414156","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050969 = Hospital System Supply Identifier | 414156 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X34","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050970","type":"LOCAL"},{"code":"414157","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050970 = Hospital System Supply Identifier | 414157 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X36","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050971","type":"LOCAL"},{"code":"414158","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050971 = Hospital System Supply Identifier | 414158 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X38","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050972","type":"LOCAL"},{"code":"414159","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050972 = Hospital System Supply Identifier | 414159 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X46","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050974","type":"LOCAL"},{"code":"414161","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050974 = Hospital System Supply Identifier | 414161 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X40","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050973","type":"LOCAL"},{"code":"414160","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050973 = Hospital System Supply Identifier | 414160 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X48","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050742","type":"LOCAL"},{"code":"399854","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050742 = Hospital System Supply Identifier | 399854 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X42","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050740","type":"LOCAL"},{"code":"399852","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050740 = Hospital System Supply Identifier | 399852 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X44","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050741","type":"LOCAL"},{"code":"399853","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050741 = Hospital System Supply Identifier | 399853 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X52","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050743","type":"LOCAL"},{"code":"399855","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050743 = Hospital System Supply Identifier | 399855 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X54","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050744","type":"LOCAL"},{"code":"399856","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050744 = Hospital System Supply Identifier | 399856 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X50","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050975","type":"LOCAL"},{"code":"414162","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050975 = Hospital System Supply Identifier | 414162 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X56","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050976","type":"LOCAL"},{"code":"414163","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050976 = Hospital System Supply Identifier | 414163 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X58","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050977","type":"LOCAL"},{"code":"414164","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050977 = Hospital System Supply Identifier | 414164 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X60","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050745","type":"LOCAL"},{"code":"399857","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050745 = Hospital System Supply Identifier | 399857 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X65","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050978","type":"LOCAL"},{"code":"414165","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050978 = Hospital System Supply Identifier | 414165 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X75","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050747","type":"LOCAL"},{"code":"399859","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050747 = Hospital System Supply Identifier | 399859 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X70","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050746","type":"LOCAL"},{"code":"399858","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050746 = Hospital System Supply Identifier | 399858 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X80","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050979","type":"LOCAL"},{"code":"414166","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050979 = Hospital System Supply Identifier | 414166 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X85","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050980","type":"LOCAL"},{"code":"414167","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050980 = Hospital System Supply Identifier | 414167 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X90","code_information":[{"code":"Sx00-1050-459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050981","type":"LOCAL"},{"code":"414168","type":"LOCAL"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050981 = Hospital System Supply Identifier | 414168 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X10","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050982","type":"LOCAL"},{"code":"414169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050982 = Hospital System Supply Identifier | 414169 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X12","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050983","type":"LOCAL"},{"code":"414170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050983 = Hospital System Supply Identifier | 414170 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X14","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050984","type":"LOCAL"},{"code":"414171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050984 = Hospital System Supply Identifier | 414171 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X16","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050985","type":"LOCAL"},{"code":"414172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050985 = Hospital System Supply Identifier | 414172 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X18","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050986","type":"LOCAL"},{"code":"414173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050986 = Hospital System Supply Identifier | 414173 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X24","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050989","type":"LOCAL"},{"code":"414176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050989 = Hospital System Supply Identifier | 414176 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X22","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050988","type":"LOCAL"},{"code":"414175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050988 = Hospital System Supply Identifier | 414175 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X28MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050749","type":"LOCAL"},{"code":"399861","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050749 = Hospital System Supply Identifier | 399861 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X26MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050748","type":"LOCAL"},{"code":"399860","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050748 = Hospital System Supply Identifier | 399860 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X20","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050987","type":"LOCAL"},{"code":"414174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050987 = Hospital System Supply Identifier | 414174 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X30MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050750","type":"LOCAL"},{"code":"399862","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050750 = Hospital System Supply Identifier | 399862 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X32MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050751","type":"LOCAL"},{"code":"399863","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050751 = Hospital System Supply Identifier | 399863 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X34MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050752","type":"LOCAL"},{"code":"399864","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050752 = Hospital System Supply Identifier | 399864 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X38MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050753","type":"LOCAL"},{"code":"399865","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050753 = Hospital System Supply Identifier | 399865 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X36","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050990","type":"LOCAL"},{"code":"414177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050990 = Hospital System Supply Identifier | 414177 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X40","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050991","type":"LOCAL"},{"code":"414178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050991 = Hospital System Supply Identifier | 414178 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X48MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050757","type":"LOCAL"},{"code":"399869","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050757 = Hospital System Supply Identifier | 399869 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X44MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050755","type":"LOCAL"},{"code":"399867","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050755 = Hospital System Supply Identifier | 399867 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X42MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050754","type":"LOCAL"},{"code":"399866","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050754 = Hospital System Supply Identifier | 399866 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X46MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050756","type":"LOCAL"},{"code":"399868","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050756 = Hospital System Supply Identifier | 399868 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X52MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050758","type":"LOCAL"},{"code":"399870","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050758 = Hospital System Supply Identifier | 399870 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X56MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050759","type":"LOCAL"},{"code":"399871","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050759 = Hospital System Supply Identifier | 399871 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X58MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050760","type":"LOCAL"},{"code":"399872","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050760 = Hospital System Supply Identifier | 399872 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X50","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050992","type":"LOCAL"},{"code":"414179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050992 = Hospital System Supply Identifier | 414179 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X54","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050993","type":"LOCAL"},{"code":"414180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050993 = Hospital System Supply Identifier | 414180 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X60MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050761","type":"LOCAL"},{"code":"399873","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050761 = Hospital System Supply Identifier | 399873 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X65MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050762","type":"LOCAL"},{"code":"399874","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050762 = Hospital System Supply Identifier | 399874 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X70","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050994","type":"LOCAL"},{"code":"414181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050994 = Hospital System Supply Identifier | 414181 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X75","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050995","type":"LOCAL"},{"code":"414182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050995 = Hospital System Supply Identifier | 414182 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X80","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050996","type":"LOCAL"},{"code":"414183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050996 = Hospital System Supply Identifier | 414183 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X85","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050997","type":"LOCAL"},{"code":"414184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050997 = Hospital System Supply Identifier | 414184 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X90","code_information":[{"code":"Sx00-1050-469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1050998","type":"LOCAL"},{"code":"414185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1577.07,"discounted_cash":551.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1050998 = Hospital System Supply Identifier | 414185 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054385","type":"LOCAL"},{"code":"876835","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054385 = Hospital System Supply Identifier | 876835 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054386","type":"LOCAL"},{"code":"876836","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054386 = Hospital System Supply Identifier | 876836 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054388","type":"LOCAL"},{"code":"876838","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054388 = Hospital System Supply Identifier | 876838 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054387","type":"LOCAL"},{"code":"876837","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054387 = Hospital System Supply Identifier | 876837 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054390","type":"LOCAL"},{"code":"876840","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054390 = Hospital System Supply Identifier | 876840 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 4H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054389","type":"LOCAL"},{"code":"876839","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054389 = Hospital System Supply Identifier | 876839 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054391","type":"LOCAL"},{"code":"876841","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054391 = Hospital System Supply Identifier | 876841 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054392","type":"LOCAL"},{"code":"876842","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054392 = Hospital System Supply Identifier | 876842 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054393","type":"LOCAL"},{"code":"876843","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054393 = Hospital System Supply Identifier | 876843 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054394","type":"LOCAL"},{"code":"876844","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054394 = Hospital System Supply Identifier | 876844 = Lawson ID"}]},{"description":"PLATE BONE 4.5MM 90D DFOS 18D","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"971153","type":"LOCAL"},{"code":"841865","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 971153 = Hospital System Supply Identifier | 841865 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054395","type":"LOCAL"},{"code":"876845","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054395 = Hospital System Supply Identifier | 876845 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054396","type":"LOCAL"},{"code":"876846","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054396 = Hospital System Supply Identifier | 876846 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054397","type":"LOCAL"},{"code":"876847","type":"LOCAL"}],"standard_charges":[{"gross_charge":14552.0,"discounted_cash":5093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054397 = Hospital System Supply Identifier | 876847 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054399","type":"LOCAL"},{"code":"876849","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054399 = Hospital System Supply Identifier | 876849 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054398","type":"LOCAL"},{"code":"876848","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054398 = Hospital System Supply Identifier | 876848 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ4","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054400","type":"LOCAL"},{"code":"876850","type":"LOCAL"}],"standard_charges":[{"gross_charge":12314.34,"discounted_cash":4310.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054400 = Hospital System Supply Identifier | 876850 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ6","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054401","type":"LOCAL"},{"code":"876851","type":"LOCAL"}],"standard_charges":[{"gross_charge":12612.33,"discounted_cash":4414.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054401 = Hospital System Supply Identifier | 876851 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ8","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054402","type":"LOCAL"},{"code":"876852","type":"LOCAL"}],"standard_charges":[{"gross_charge":12846.42,"discounted_cash":4496.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054402 = Hospital System Supply Identifier | 876852 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ10","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054403","type":"LOCAL"},{"code":"876853","type":"LOCAL"}],"standard_charges":[{"gross_charge":13143.02,"discounted_cash":4600.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054403 = Hospital System Supply Identifier | 876853 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ12","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054404","type":"LOCAL"},{"code":"876854","type":"LOCAL"}],"standard_charges":[{"gross_charge":13439.62,"discounted_cash":4703.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054404 = Hospital System Supply Identifier | 876854 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ14","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054405","type":"LOCAL"},{"code":"876855","type":"LOCAL"}],"standard_charges":[{"gross_charge":13736.23,"discounted_cash":4807.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054405 = Hospital System Supply Identifier | 876855 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ16","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054406","type":"LOCAL"},{"code":"876856","type":"LOCAL"}],"standard_charges":[{"gross_charge":15957.9,"discounted_cash":5585.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054406 = Hospital System Supply Identifier | 876856 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ6","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054408","type":"LOCAL"},{"code":"876858","type":"LOCAL"}],"standard_charges":[{"gross_charge":12612.33,"discounted_cash":4414.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054408 = Hospital System Supply Identifier | 876858 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ8","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054409","type":"LOCAL"},{"code":"876859","type":"LOCAL"}],"standard_charges":[{"gross_charge":12846.42,"discounted_cash":4496.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054409 = Hospital System Supply Identifier | 876859 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ4","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054407","type":"LOCAL"},{"code":"876857","type":"LOCAL"}],"standard_charges":[{"gross_charge":12314.34,"discounted_cash":4310.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054407 = Hospital System Supply Identifier | 876857 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ10","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054410","type":"LOCAL"},{"code":"876860","type":"LOCAL"}],"standard_charges":[{"gross_charge":13143.02,"discounted_cash":4600.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054410 = Hospital System Supply Identifier | 876860 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ12","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054411","type":"LOCAL"},{"code":"876861","type":"LOCAL"}],"standard_charges":[{"gross_charge":13439.62,"discounted_cash":4703.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054411 = Hospital System Supply Identifier | 876861 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ14","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054412","type":"LOCAL"},{"code":"876862","type":"LOCAL"}],"standard_charges":[{"gross_charge":13736.23,"discounted_cash":4807.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054412 = Hospital System Supply Identifier | 876862 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ16","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054413","type":"LOCAL"},{"code":"876863","type":"LOCAL"}],"standard_charges":[{"gross_charge":15957.9,"discounted_cash":5585.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054413 = Hospital System Supply Identifier | 876863 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 16HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054417","type":"LOCAL"},{"code":"876867","type":"LOCAL"}],"standard_charges":[{"gross_charge":11741.58,"discounted_cash":4109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054417 = Hospital System Supply Identifier | 876867 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 10HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054414","type":"LOCAL"},{"code":"876864","type":"LOCAL"}],"standard_charges":[{"gross_charge":9119.88,"discounted_cash":3191.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054414 = Hospital System Supply Identifier | 876864 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 12HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054415","type":"LOCAL"},{"code":"876865","type":"LOCAL"}],"standard_charges":[{"gross_charge":9480.24,"discounted_cash":3318.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054415 = Hospital System Supply Identifier | 876865 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 14HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054416","type":"LOCAL"},{"code":"876866","type":"LOCAL"}],"standard_charges":[{"gross_charge":10092.87,"discounted_cash":3532.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054416 = Hospital System Supply Identifier | 876866 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 18HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054418","type":"LOCAL"},{"code":"876868","type":"LOCAL"}],"standard_charges":[{"gross_charge":12120.84,"discounted_cash":4242.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054418 = Hospital System Supply Identifier | 876868 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ8","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054421","type":"LOCAL"},{"code":"876871","type":"LOCAL"}],"standard_charges":[{"gross_charge":15024.6,"discounted_cash":5258.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054421 = Hospital System Supply Identifier | 876871 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ4","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054419","type":"LOCAL"},{"code":"876869","type":"LOCAL"}],"standard_charges":[{"gross_charge":14394.92,"discounted_cash":5038.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054419 = Hospital System Supply Identifier | 876869 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ6","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054420","type":"LOCAL"},{"code":"876870","type":"LOCAL"}],"standard_charges":[{"gross_charge":14760.86,"discounted_cash":5166.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054420 = Hospital System Supply Identifier | 876870 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ16","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054425","type":"LOCAL"},{"code":"876875","type":"LOCAL"}],"standard_charges":[{"gross_charge":17136.57,"discounted_cash":5997.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054425 = Hospital System Supply Identifier | 876875 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ10","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054422","type":"LOCAL"},{"code":"876872","type":"LOCAL"}],"standard_charges":[{"gross_charge":16156.8,"discounted_cash":5654.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054422 = Hospital System Supply Identifier | 876872 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ12","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054423","type":"LOCAL"},{"code":"876873","type":"LOCAL"}],"standard_charges":[{"gross_charge":16535.47,"discounted_cash":5787.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054423 = Hospital System Supply Identifier | 876873 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ14","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054424","type":"LOCAL"},{"code":"876874","type":"LOCAL"}],"standard_charges":[{"gross_charge":16910.32,"discounted_cash":5918.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054424 = Hospital System Supply Identifier | 876874 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ18","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054426","type":"LOCAL"},{"code":"876876","type":"LOCAL"}],"standard_charges":[{"gross_charge":18522.84,"discounted_cash":6482.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054426 = Hospital System Supply Identifier | 876876 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ6","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054428","type":"LOCAL"},{"code":"876878","type":"LOCAL"}],"standard_charges":[{"gross_charge":14760.86,"discounted_cash":5166.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054428 = Hospital System Supply Identifier | 876878 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ4","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054427","type":"LOCAL"},{"code":"876877","type":"LOCAL"}],"standard_charges":[{"gross_charge":14394.92,"discounted_cash":5038.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054427 = Hospital System Supply Identifier | 876877 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ8","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054429","type":"LOCAL"},{"code":"876879","type":"LOCAL"}],"standard_charges":[{"gross_charge":15024.6,"discounted_cash":5258.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054429 = Hospital System Supply Identifier | 876879 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ18","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054434","type":"LOCAL"},{"code":"876884","type":"LOCAL"}],"standard_charges":[{"gross_charge":18522.84,"discounted_cash":6482.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054434 = Hospital System Supply Identifier | 876884 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ16","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054433","type":"LOCAL"},{"code":"876883","type":"LOCAL"}],"standard_charges":[{"gross_charge":17136.57,"discounted_cash":5997.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054433 = Hospital System Supply Identifier | 876883 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ14","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054432","type":"LOCAL"},{"code":"876882","type":"LOCAL"}],"standard_charges":[{"gross_charge":16910.32,"discounted_cash":5918.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054432 = Hospital System Supply Identifier | 876882 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ12","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054431","type":"LOCAL"},{"code":"876881","type":"LOCAL"}],"standard_charges":[{"gross_charge":16535.47,"discounted_cash":5787.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054431 = Hospital System Supply Identifier | 876881 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ10","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054430","type":"LOCAL"},{"code":"876880","type":"LOCAL"}],"standard_charges":[{"gross_charge":16156.8,"discounted_cash":5654.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054430 = Hospital System Supply Identifier | 876880 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054435","type":"LOCAL"},{"code":"876885","type":"LOCAL"}],"standard_charges":[{"gross_charge":9480.24,"discounted_cash":3318.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054435 = Hospital System Supply Identifier | 876885 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 12HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054436","type":"LOCAL"},{"code":"876886","type":"LOCAL"}],"standard_charges":[{"gross_charge":9836.64,"discounted_cash":3442.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054436 = Hospital System Supply Identifier | 876886 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054437","type":"LOCAL"},{"code":"876887","type":"LOCAL"}],"standard_charges":[{"gross_charge":10276.87,"discounted_cash":3596.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054437 = Hospital System Supply Identifier | 876887 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 16HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054438","type":"LOCAL"},{"code":"876888","type":"LOCAL"}],"standard_charges":[{"gross_charge":11950.56,"discounted_cash":4182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054438 = Hospital System Supply Identifier | 876888 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 18HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054439","type":"LOCAL"},{"code":"876889","type":"LOCAL"}],"standard_charges":[{"gross_charge":12476.88,"discounted_cash":4366.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054439 = Hospital System Supply Identifier | 876889 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 6HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054441","type":"LOCAL"},{"code":"876891","type":"LOCAL"}],"standard_charges":[{"gross_charge":7816.5,"discounted_cash":2735.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054441 = Hospital System Supply Identifier | 876891 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 8HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054442","type":"LOCAL"},{"code":"876892","type":"LOCAL"}],"standard_charges":[{"gross_charge":8658.81,"discounted_cash":3030.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054442 = Hospital System Supply Identifier | 876892 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 4HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054440","type":"LOCAL"},{"code":"876890","type":"LOCAL"}],"standard_charges":[{"gross_charge":6880.95,"discounted_cash":2408.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054440 = Hospital System Supply Identifier | 876890 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054443","type":"LOCAL"},{"code":"876893","type":"LOCAL"}],"standard_charges":[{"gross_charge":9480.24,"discounted_cash":3318.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054443 = Hospital System Supply Identifier | 876893 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054444","type":"LOCAL"},{"code":"876894","type":"LOCAL"}],"standard_charges":[{"gross_charge":10276.87,"discounted_cash":3596.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054444 = Hospital System Supply Identifier | 876894 = Lawson ID"}]},{"description":"WASHERS","code_information":[{"code":"Sx00-1071-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054445","type":"LOCAL"},{"code":"876895","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":53.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054445 = Hospital System Supply Identifier | 876895 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X30MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054446","type":"LOCAL"},{"code":"876896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054446 = Hospital System Supply Identifier | 876896 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X35MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054447","type":"LOCAL"},{"code":"876897","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054447 = Hospital System Supply Identifier | 876897 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X40MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054448","type":"LOCAL"},{"code":"876898","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054448 = Hospital System Supply Identifier | 876898 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X45MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054449","type":"LOCAL"},{"code":"876899","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054449 = Hospital System Supply Identifier | 876899 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X50MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054450","type":"LOCAL"},{"code":"876900","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054450 = Hospital System Supply Identifier | 876900 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X55MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054451","type":"LOCAL"},{"code":"876901","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054451 = Hospital System Supply Identifier | 876901 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X65MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054453","type":"LOCAL"},{"code":"876903","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054453 = Hospital System Supply Identifier | 876903 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X60MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054452","type":"LOCAL"},{"code":"876902","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054452 = Hospital System Supply Identifier | 876902 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X70MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054454","type":"LOCAL"},{"code":"876904","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054454 = Hospital System Supply Identifier | 876904 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X75MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054455","type":"LOCAL"},{"code":"876905","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054455 = Hospital System Supply Identifier | 876905 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X80MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054456","type":"LOCAL"},{"code":"876906","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054456 = Hospital System Supply Identifier | 876906 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X85MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054457","type":"LOCAL"},{"code":"876907","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054457 = Hospital System Supply Identifier | 876907 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X90MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054458","type":"LOCAL"},{"code":"876908","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054458 = Hospital System Supply Identifier | 876908 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X95MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054459","type":"LOCAL"},{"code":"876909","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054459 = Hospital System Supply Identifier | 876909 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X105MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054461","type":"LOCAL"},{"code":"876911","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054461 = Hospital System Supply Identifier | 876911 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X100MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054460","type":"LOCAL"},{"code":"876910","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054460 = Hospital System Supply Identifier | 876910 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X115MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054463","type":"LOCAL"},{"code":"876913","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054463 = Hospital System Supply Identifier | 876913 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X110MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054462","type":"LOCAL"},{"code":"876912","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054462 = Hospital System Supply Identifier | 876912 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X120MM","code_information":[{"code":"Sx00-1071-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054464","type":"LOCAL"},{"code":"876914","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054464 = Hospital System Supply Identifier | 876914 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054465","type":"LOCAL"},{"code":"876915","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054465 = Hospital System Supply Identifier | 876915 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054466","type":"LOCAL"},{"code":"876916","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054466 = Hospital System Supply Identifier | 876916 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054467","type":"LOCAL"},{"code":"876917","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054467 = Hospital System Supply Identifier | 876917 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054468","type":"LOCAL"},{"code":"876918","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054468 = Hospital System Supply Identifier | 876918 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054469","type":"LOCAL"},{"code":"876919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054469 = Hospital System Supply Identifier | 876919 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054470","type":"LOCAL"},{"code":"876920","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054470 = Hospital System Supply Identifier | 876920 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054472","type":"LOCAL"},{"code":"876922","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054472 = Hospital System Supply Identifier | 876922 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054471","type":"LOCAL"},{"code":"876921","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054471 = Hospital System Supply Identifier | 876921 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054474","type":"LOCAL"},{"code":"876924","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054474 = Hospital System Supply Identifier | 876924 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054473","type":"LOCAL"},{"code":"876923","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054473 = Hospital System Supply Identifier | 876923 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054475","type":"LOCAL"},{"code":"876925","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054475 = Hospital System Supply Identifier | 876925 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054476","type":"LOCAL"},{"code":"876926","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054476 = Hospital System Supply Identifier | 876926 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054477","type":"LOCAL"},{"code":"876927","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054477 = Hospital System Supply Identifier | 876927 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054478","type":"LOCAL"},{"code":"876928","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054478 = Hospital System Supply Identifier | 876928 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054479","type":"LOCAL"},{"code":"876929","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054479 = Hospital System Supply Identifier | 876929 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X30MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054480","type":"LOCAL"},{"code":"876930","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054480 = Hospital System Supply Identifier | 876930 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X35MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054481","type":"LOCAL"},{"code":"876931","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054481 = Hospital System Supply Identifier | 876931 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X40MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054482","type":"LOCAL"},{"code":"876932","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054482 = Hospital System Supply Identifier | 876932 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X45MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054483","type":"LOCAL"},{"code":"876933","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054483 = Hospital System Supply Identifier | 876933 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054485","type":"LOCAL"},{"code":"876935","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054485 = Hospital System Supply Identifier | 876935 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054484","type":"LOCAL"},{"code":"876934","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054484 = Hospital System Supply Identifier | 876934 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054486","type":"LOCAL"},{"code":"876936","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054486 = Hospital System Supply Identifier | 876936 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054487","type":"LOCAL"},{"code":"876937","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054487 = Hospital System Supply Identifier | 876937 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054488","type":"LOCAL"},{"code":"876938","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054488 = Hospital System Supply Identifier | 876938 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054489","type":"LOCAL"},{"code":"876939","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054489 = Hospital System Supply Identifier | 876939 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054490","type":"LOCAL"},{"code":"876940","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054490 = Hospital System Supply Identifier | 876940 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054491","type":"LOCAL"},{"code":"876941","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054491 = Hospital System Supply Identifier | 876941 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054492","type":"LOCAL"},{"code":"876942","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054492 = Hospital System Supply Identifier | 876942 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054493","type":"LOCAL"},{"code":"876943","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054493 = Hospital System Supply Identifier | 876943 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054495","type":"LOCAL"},{"code":"876945","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054495 = Hospital System Supply Identifier | 876945 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054494","type":"LOCAL"},{"code":"876944","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054494 = Hospital System Supply Identifier | 876944 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054496","type":"LOCAL"},{"code":"876946","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054496 = Hospital System Supply Identifier | 876946 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054497","type":"LOCAL"},{"code":"876947","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054497 = Hospital System Supply Identifier | 876947 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054498","type":"LOCAL"},{"code":"876948","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054498 = Hospital System Supply Identifier | 876948 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054503","type":"LOCAL"},{"code":"876953","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054503 = Hospital System Supply Identifier | 876953 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X17MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054502","type":"LOCAL"},{"code":"876952","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054502 = Hospital System Supply Identifier | 876952 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X19MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054504","type":"LOCAL"},{"code":"876954","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054504 = Hospital System Supply Identifier | 876954 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X15MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054500","type":"LOCAL"},{"code":"876950","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054500 = Hospital System Supply Identifier | 876950 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054499","type":"LOCAL"},{"code":"876949","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054499 = Hospital System Supply Identifier | 876949 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054501","type":"LOCAL"},{"code":"876951","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054501 = Hospital System Supply Identifier | 876951 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054505","type":"LOCAL"},{"code":"876955","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054505 = Hospital System Supply Identifier | 876955 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X21MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054506","type":"LOCAL"},{"code":"876956","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054506 = Hospital System Supply Identifier | 876956 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054507","type":"LOCAL"},{"code":"876957","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054507 = Hospital System Supply Identifier | 876957 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X23MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054508","type":"LOCAL"},{"code":"876958","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054508 = Hospital System Supply Identifier | 876958 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054509","type":"LOCAL"},{"code":"876959","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054509 = Hospital System Supply Identifier | 876959 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054510","type":"LOCAL"},{"code":"876960","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054510 = Hospital System Supply Identifier | 876960 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054511","type":"LOCAL"},{"code":"876961","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054511 = Hospital System Supply Identifier | 876961 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054515","type":"LOCAL"},{"code":"876965","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054515 = Hospital System Supply Identifier | 876965 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054514","type":"LOCAL"},{"code":"876964","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054514 = Hospital System Supply Identifier | 876964 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054516","type":"LOCAL"},{"code":"876966","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054516 = Hospital System Supply Identifier | 876966 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054512","type":"LOCAL"},{"code":"876962","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054512 = Hospital System Supply Identifier | 876962 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054513","type":"LOCAL"},{"code":"876963","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054513 = Hospital System Supply Identifier | 876963 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054517","type":"LOCAL"},{"code":"876967","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054517 = Hospital System Supply Identifier | 876967 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054518","type":"LOCAL"},{"code":"876968","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054518 = Hospital System Supply Identifier | 876968 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1071-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054519","type":"LOCAL"},{"code":"876969","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054519 = Hospital System Supply Identifier | 876969 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X10MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054520","type":"LOCAL"},{"code":"876970","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054520 = Hospital System Supply Identifier | 876970 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X11MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054521","type":"LOCAL"},{"code":"876971","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054521 = Hospital System Supply Identifier | 876971 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X12MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054522","type":"LOCAL"},{"code":"876972","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054522 = Hospital System Supply Identifier | 876972 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X13MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054523","type":"LOCAL"},{"code":"876973","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054523 = Hospital System Supply Identifier | 876973 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X14MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054524","type":"LOCAL"},{"code":"876974","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054524 = Hospital System Supply Identifier | 876974 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X15MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054525","type":"LOCAL"},{"code":"876975","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054525 = Hospital System Supply Identifier | 876975 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X16MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054526","type":"LOCAL"},{"code":"876976","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054526 = Hospital System Supply Identifier | 876976 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X17MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054527","type":"LOCAL"},{"code":"876977","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054527 = Hospital System Supply Identifier | 876977 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X18MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054528","type":"LOCAL"},{"code":"876978","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054528 = Hospital System Supply Identifier | 876978 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X19MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054529","type":"LOCAL"},{"code":"876979","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054529 = Hospital System Supply Identifier | 876979 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X26MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054535","type":"LOCAL"},{"code":"876985","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054535 = Hospital System Supply Identifier | 876985 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X24MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054534","type":"LOCAL"},{"code":"876984","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054534 = Hospital System Supply Identifier | 876984 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X23MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054533","type":"LOCAL"},{"code":"876983","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054533 = Hospital System Supply Identifier | 876983 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X28MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054536","type":"LOCAL"},{"code":"876986","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054536 = Hospital System Supply Identifier | 876986 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X21MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054531","type":"LOCAL"},{"code":"876981","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054531 = Hospital System Supply Identifier | 876981 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X20MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054530","type":"LOCAL"},{"code":"876980","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054530 = Hospital System Supply Identifier | 876980 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X22MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054532","type":"LOCAL"},{"code":"876982","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054532 = Hospital System Supply Identifier | 876982 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X38MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054541","type":"LOCAL"},{"code":"876991","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054541 = Hospital System Supply Identifier | 876991 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X36MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054540","type":"LOCAL"},{"code":"876990","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054540 = Hospital System Supply Identifier | 876990 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X30MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054537","type":"LOCAL"},{"code":"876987","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054537 = Hospital System Supply Identifier | 876987 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X32MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054538","type":"LOCAL"},{"code":"876988","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054538 = Hospital System Supply Identifier | 876988 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X34MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054539","type":"LOCAL"},{"code":"876989","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054539 = Hospital System Supply Identifier | 876989 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X40MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054542","type":"LOCAL"},{"code":"876992","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054542 = Hospital System Supply Identifier | 876992 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X45MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054543","type":"LOCAL"},{"code":"876993","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054543 = Hospital System Supply Identifier | 876993 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X50MM","code_information":[{"code":"Sx00-1071-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054544","type":"LOCAL"},{"code":"876994","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054544 = Hospital System Supply Identifier | 876994 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X18MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054549","type":"LOCAL"},{"code":"876999","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054549 = Hospital System Supply Identifier | 876999 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X14MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054547","type":"LOCAL"},{"code":"876997","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054547 = Hospital System Supply Identifier | 876997 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X16MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054548","type":"LOCAL"},{"code":"876998","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054548 = Hospital System Supply Identifier | 876998 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X12MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054546","type":"LOCAL"},{"code":"876996","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054546 = Hospital System Supply Identifier | 876996 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X10MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054545","type":"LOCAL"},{"code":"876995","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054545 = Hospital System Supply Identifier | 876995 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X20MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054550","type":"LOCAL"},{"code":"877000","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054550 = Hospital System Supply Identifier | 877000 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X22MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054551","type":"LOCAL"},{"code":"877001","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054551 = Hospital System Supply Identifier | 877001 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X24MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054552","type":"LOCAL"},{"code":"877002","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054552 = Hospital System Supply Identifier | 877002 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X26MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054553","type":"LOCAL"},{"code":"877003","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054553 = Hospital System Supply Identifier | 877003 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X28MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054554","type":"LOCAL"},{"code":"877004","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054554 = Hospital System Supply Identifier | 877004 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X35MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054558","type":"LOCAL"},{"code":"877008","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054558 = Hospital System Supply Identifier | 877008 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X38MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054560","type":"LOCAL"},{"code":"877010","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054560 = Hospital System Supply Identifier | 877010 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X36MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054559","type":"LOCAL"},{"code":"877009","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054559 = Hospital System Supply Identifier | 877009 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X34MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054557","type":"LOCAL"},{"code":"877007","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054557 = Hospital System Supply Identifier | 877007 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X30MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054555","type":"LOCAL"},{"code":"877005","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054555 = Hospital System Supply Identifier | 877005 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X32MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054556","type":"LOCAL"},{"code":"877006","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054556 = Hospital System Supply Identifier | 877006 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X40MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054561","type":"LOCAL"},{"code":"877011","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054561 = Hospital System Supply Identifier | 877011 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X42MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054562","type":"LOCAL"},{"code":"877012","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054562 = Hospital System Supply Identifier | 877012 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X44MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054563","type":"LOCAL"},{"code":"877013","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054563 = Hospital System Supply Identifier | 877013 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X45MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054564","type":"LOCAL"},{"code":"877014","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054564 = Hospital System Supply Identifier | 877014 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X46MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054565","type":"LOCAL"},{"code":"877015","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054565 = Hospital System Supply Identifier | 877015 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X48MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054566","type":"LOCAL"},{"code":"877016","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054566 = Hospital System Supply Identifier | 877016 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X55MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054568","type":"LOCAL"},{"code":"877018","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054568 = Hospital System Supply Identifier | 877018 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X50MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054567","type":"LOCAL"},{"code":"877017","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054567 = Hospital System Supply Identifier | 877017 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X60MM","code_information":[{"code":"Sx00-1071-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054569","type":"LOCAL"},{"code":"877019","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054569 = Hospital System Supply Identifier | 877019 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054570","type":"LOCAL"},{"code":"877020","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054570 = Hospital System Supply Identifier | 877020 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054571","type":"LOCAL"},{"code":"877021","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054571 = Hospital System Supply Identifier | 877021 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054572","type":"LOCAL"},{"code":"877022","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054572 = Hospital System Supply Identifier | 877022 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054573","type":"LOCAL"},{"code":"877023","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054573 = Hospital System Supply Identifier | 877023 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054574","type":"LOCAL"},{"code":"877024","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054574 = Hospital System Supply Identifier | 877024 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054578","type":"LOCAL"},{"code":"877028","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054578 = Hospital System Supply Identifier | 877028 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054577","type":"LOCAL"},{"code":"877027","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054577 = Hospital System Supply Identifier | 877027 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054579","type":"LOCAL"},{"code":"877029","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054579 = Hospital System Supply Identifier | 877029 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054575","type":"LOCAL"},{"code":"877025","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054575 = Hospital System Supply Identifier | 877025 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054576","type":"LOCAL"},{"code":"877026","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054576 = Hospital System Supply Identifier | 877026 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054580","type":"LOCAL"},{"code":"877030","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054580 = Hospital System Supply Identifier | 877030 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054581","type":"LOCAL"},{"code":"877031","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054581 = Hospital System Supply Identifier | 877031 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054582","type":"LOCAL"},{"code":"877032","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054582 = Hospital System Supply Identifier | 877032 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054583","type":"LOCAL"},{"code":"877033","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054583 = Hospital System Supply Identifier | 877033 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054584","type":"LOCAL"},{"code":"877034","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054584 = Hospital System Supply Identifier | 877034 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054585","type":"LOCAL"},{"code":"877035","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054585 = Hospital System Supply Identifier | 877035 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054586","type":"LOCAL"},{"code":"877036","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054586 = Hospital System Supply Identifier | 877036 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054587","type":"LOCAL"},{"code":"877037","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054587 = Hospital System Supply Identifier | 877037 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054592","type":"LOCAL"},{"code":"877042","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054592 = Hospital System Supply Identifier | 877042 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054591","type":"LOCAL"},{"code":"877041","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054591 = Hospital System Supply Identifier | 877041 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054588","type":"LOCAL"},{"code":"877038","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054588 = Hospital System Supply Identifier | 877038 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054589","type":"LOCAL"},{"code":"877039","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054589 = Hospital System Supply Identifier | 877039 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054590","type":"LOCAL"},{"code":"877040","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054590 = Hospital System Supply Identifier | 877040 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054593","type":"LOCAL"},{"code":"877043","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054593 = Hospital System Supply Identifier | 877043 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054594","type":"LOCAL"},{"code":"877044","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054594 = Hospital System Supply Identifier | 877044 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054595","type":"LOCAL"},{"code":"877045","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054595 = Hospital System Supply Identifier | 877045 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054596","type":"LOCAL"},{"code":"877046","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054596 = Hospital System Supply Identifier | 877046 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054597","type":"LOCAL"},{"code":"877047","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054597 = Hospital System Supply Identifier | 877047 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054601","type":"LOCAL"},{"code":"877051","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054601 = Hospital System Supply Identifier | 877051 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054600","type":"LOCAL"},{"code":"877050","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054600 = Hospital System Supply Identifier | 877050 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054602","type":"LOCAL"},{"code":"877052","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054602 = Hospital System Supply Identifier | 877052 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054598","type":"LOCAL"},{"code":"877048","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054598 = Hospital System Supply Identifier | 877048 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054599","type":"LOCAL"},{"code":"877049","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054599 = Hospital System Supply Identifier | 877049 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054603","type":"LOCAL"},{"code":"877053","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054603 = Hospital System Supply Identifier | 877053 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054604","type":"LOCAL"},{"code":"877054","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054604 = Hospital System Supply Identifier | 877054 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054605","type":"LOCAL"},{"code":"877055","type":"LOCAL"}],"standard_charges":[{"gross_charge":1039.5,"discounted_cash":363.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054605 = Hospital System Supply Identifier | 877055 = Lawson ID"}]},{"description":"CEM BONE DOUGH-TYPE 40/20","code_information":[{"code":"Sx00-1102-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"34976","type":"LOCAL"},{"code":"100111","type":"LOCAL"}],"standard_charges":[{"gross_charge":339.5,"discounted_cash":118.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 34976 = Hospital System Supply Identifier | 100111 = Lawson ID"}]},{"description":"CEM BONE PALACOS-R 40GM","code_information":[{"code":"Sx00-1112-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17042","type":"LOCAL"},{"code":"141046","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17042 = Hospital System Supply Identifier | 141046 = Lawson ID"}]},{"description":"OFF CONTRACT USE 702836 - CEM BONE PALACOS-R/G 40GM","code_information":[{"code":"Sx00-1113-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"20122","type":"LOCAL"},{"code":"238388","type":"LOCAL"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 20122 = Hospital System Supply Identifier | 238388 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV 40GM","code_information":[{"code":"Sx00-1118-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176736","type":"LOCAL"},{"code":"308782","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 176736 = Hospital System Supply Identifier | 308782 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV/G 40GM","code_information":[{"code":"Sx00-1119-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176737","type":"LOCAL"},{"code":"308783","type":"LOCAL"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 176737 = Hospital System Supply Identifier | 308783 = Lawson ID"}]},{"description":"INST DRIVER SCRW MINI MAGNA","code_information":[{"code":"Sx00-1142-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"149709","type":"LOCAL"},{"code":"237164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1351.35,"discounted_cash":472.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 149709 = Hospital System Supply Identifier | 237164 = Lawson ID"}]},{"description":"DISC - DRILL CANNUL 3.5","code_information":[{"code":"Sx00-1142-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"166679","type":"LOCAL"},{"code":"148674","type":"LOCAL"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166679 = Hospital System Supply Identifier | 148674 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X65MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408714","type":"LOCAL"},{"code":"339432","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408714 = Hospital System Supply Identifier | 339432 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X32MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408713","type":"LOCAL"},{"code":"339431","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408713 = Hospital System Supply Identifier | 339431 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X28MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408712","type":"LOCAL"},{"code":"339430","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408712 = Hospital System Supply Identifier | 339430 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X48MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408416","type":"LOCAL"},{"code":"323779","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408416 = Hospital System Supply Identifier | 323779 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X40MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148464","type":"LOCAL"},{"code":"235491","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148464 = Hospital System Supply Identifier | 235491 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X44MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148465","type":"LOCAL"},{"code":"235492","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148465 = Hospital System Supply Identifier | 235492 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X36MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148463","type":"LOCAL"},{"code":"235490","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148463 = Hospital System Supply Identifier | 235490 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X55MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148466","type":"LOCAL"},{"code":"235493","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148466 = Hospital System Supply Identifier | 235493 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X55MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148477","type":"LOCAL"},{"code":"235504","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148477 = Hospital System Supply Identifier | 235504 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X60MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408718","type":"LOCAL"},{"code":"339437","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408718 = Hospital System Supply Identifier | 339437 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X48MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408717","type":"LOCAL"},{"code":"339436","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408717 = Hospital System Supply Identifier | 339436 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X36MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408716","type":"LOCAL"},{"code":"339435","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408716 = Hospital System Supply Identifier | 339435 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X30MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408715","type":"LOCAL"},{"code":"339434","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408715 = Hospital System Supply Identifier | 339434 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X50MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148476","type":"LOCAL"},{"code":"235503","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148476 = Hospital System Supply Identifier | 235503 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X38MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148471","type":"LOCAL"},{"code":"235498","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148471 = Hospital System Supply Identifier | 235498 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X44MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148474","type":"LOCAL"},{"code":"235501","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148474 = Hospital System Supply Identifier | 235501 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X42MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148473","type":"LOCAL"},{"code":"235500","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148473 = Hospital System Supply Identifier | 235500 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X40MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148472","type":"LOCAL"},{"code":"235499","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148472 = Hospital System Supply Identifier | 235499 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X34MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148470","type":"LOCAL"},{"code":"235497","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148470 = Hospital System Supply Identifier | 235497 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X32MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148469","type":"LOCAL"},{"code":"235496","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148469 = Hospital System Supply Identifier | 235496 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X46MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148475","type":"LOCAL"},{"code":"235502","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":279.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148475 = Hospital System Supply Identifier | 235502 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X44MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148495","type":"LOCAL"},{"code":"235526","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148495 = Hospital System Supply Identifier | 235526 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X48MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148496","type":"LOCAL"},{"code":"235527","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148496 = Hospital System Supply Identifier | 235527 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X55MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"148497","type":"LOCAL"},{"code":"235528","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 148497 = Hospital System Supply Identifier | 235528 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X12MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408719","type":"LOCAL"},{"code":"339439","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408719 = Hospital System Supply Identifier | 339439 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X16MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408720","type":"LOCAL"},{"code":"339440","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408720 = Hospital System Supply Identifier | 339440 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X65MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408721","type":"LOCAL"},{"code":"339443","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408721 = Hospital System Supply Identifier | 339443 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X55","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35084","type":"LOCAL"},{"code":"116083","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35084 = Hospital System Supply Identifier | 116083 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X65","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35086","type":"LOCAL"},{"code":"116086","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35086 = Hospital System Supply Identifier | 116086 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X60","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35085","type":"LOCAL"},{"code":"116084","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35085 = Hospital System Supply Identifier | 116084 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X50","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35083","type":"LOCAL"},{"code":"116082","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35083 = Hospital System Supply Identifier | 116082 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X44","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35080","type":"LOCAL"},{"code":"116079","type":"LOCAL"}],"standard_charges":[{"gross_charge":642.7,"discounted_cash":224.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35080 = Hospital System Supply Identifier | 116079 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X48","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35082","type":"LOCAL"},{"code":"116081","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35082 = Hospital System Supply Identifier | 116081 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X40","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35078","type":"LOCAL"},{"code":"116076","type":"LOCAL"}],"standard_charges":[{"gross_charge":642.7,"discounted_cash":224.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35078 = Hospital System Supply Identifier | 116076 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X34","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35075","type":"LOCAL"},{"code":"116073","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35075 = Hospital System Supply Identifier | 116073 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X30","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"35073","type":"LOCAL"},{"code":"116071","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":284.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35073 = Hospital System Supply Identifier | 116071 = Lawson ID"}]},{"description":"DISC - TAP SURG CANN CHS SCRW 7MM","code_information":[{"code":"Sx00-1146-007","type":"CDM"},{"code":"272","type":"RC"},{"code":"407535","type":"LOCAL"},{"code":"202373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407535 = Hospital System Supply Identifier | 202373 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X30","code_information":[{"code":"Sx00-1146-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407529","type":"LOCAL"},{"code":"201497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407529 = Hospital System Supply Identifier | 201497 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X55","code_information":[{"code":"Sx00-1146-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407550","type":"LOCAL"},{"code":"205031","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407550 = Hospital System Supply Identifier | 205031 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X75","code_information":[{"code":"Sx00-1146-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407512","type":"LOCAL"},{"code":"201197","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407512 = Hospital System Supply Identifier | 201197 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408763","type":"LOCAL"},{"code":"339795","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408763 = Hospital System Supply Identifier | 339795 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407517","type":"LOCAL"},{"code":"201359","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407517 = Hospital System Supply Identifier | 201359 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53570","type":"LOCAL"},{"code":"116091","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 53570 = Hospital System Supply Identifier | 116091 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53571","type":"LOCAL"},{"code":"116092","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 53571 = Hospital System Supply Identifier | 116092 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407513","type":"LOCAL"},{"code":"201198","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407513 = Hospital System Supply Identifier | 201198 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408764","type":"LOCAL"},{"code":"339796","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408764 = Hospital System Supply Identifier | 339796 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407515","type":"LOCAL"},{"code":"201293","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407515 = Hospital System Supply Identifier | 201293 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408765","type":"LOCAL"},{"code":"339797","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408765 = Hospital System Supply Identifier | 339797 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X95","code_information":[{"code":"Sx00-1146-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407516","type":"LOCAL"},{"code":"201358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407516 = Hospital System Supply Identifier | 201358 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X100","code_information":[{"code":"Sx00-1146-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408766","type":"LOCAL"},{"code":"339799","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408766 = Hospital System Supply Identifier | 339799 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X105","code_information":[{"code":"Sx00-1146-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408767","type":"LOCAL"},{"code":"339800","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408767 = Hospital System Supply Identifier | 339800 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X110","code_information":[{"code":"Sx00-1146-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408768","type":"LOCAL"},{"code":"339801","type":"LOCAL"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408768 = Hospital System Supply Identifier | 339801 = Lawson ID"}]},{"description":"DUP USE 815633 - PIN GUIDE 1.6MM","code_information":[{"code":"Sx00-1147-006","type":"CDM"},{"code":"272","type":"RC"},{"code":"408926","type":"LOCAL"},{"code":"343898","type":"LOCAL"}],"standard_charges":[{"gross_charge":1554.69,"discounted_cash":544.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408926 = Hospital System Supply Identifier | 343898 = Lawson ID"}]},{"description":"DUP USE 815634 - PIN GUIDE 3.2MM","code_information":[{"code":"Sx00-1147-009","type":"CDM"},{"code":"272","type":"RC"},{"code":"408945","type":"LOCAL"},{"code":"343919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1554.69,"discounted_cash":544.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408945 = Hospital System Supply Identifier | 343919 = Lawson ID"}]},{"description":"DRILL CANN Q/C 2.3MM","code_information":[{"code":"Sx00-1147-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"195901","type":"LOCAL"},{"code":"395445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1248.19,"discounted_cash":436.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 195901 = Hospital System Supply Identifier | 395445 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 2.7MM","code_information":[{"code":"Sx00-1147-026","type":"CDM"},{"code":"272","type":"RC"},{"code":"193566","type":"LOCAL"},{"code":"314877","type":"LOCAL"}],"standard_charges":[{"gross_charge":1277.44,"discounted_cash":447.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 193566 = Hospital System Supply Identifier | 314877 = Lawson ID"}]},{"description":"DRILL CANN Q/C 3.2MM","code_information":[{"code":"Sx00-1147-027","type":"CDM"},{"code":"272","type":"RC"},{"code":"195829","type":"LOCAL"},{"code":"393263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1765.76,"discounted_cash":618.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 195829 = Hospital System Supply Identifier | 393263 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-028","type":"CDM"},{"code":"272","type":"RC"},{"code":"408769","type":"LOCAL"},{"code":"339806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1765.76,"discounted_cash":618.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408769 = Hospital System Supply Identifier | 339806 = Lawson ID"}]},{"description":"DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-029","type":"CDM"},{"code":"272","type":"RC"},{"code":"409110","type":"LOCAL"},{"code":"387535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1765.76,"discounted_cash":618.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409110 = Hospital System Supply Identifier | 387535 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 5.0MM","code_information":[{"code":"Sx00-1147-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"408395","type":"LOCAL"},{"code":"314162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1765.76,"discounted_cash":618.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408395 = Hospital System Supply Identifier | 314162 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 4.0MM","code_information":[{"code":"Sx00-1147-038","type":"CDM"},{"code":"272","type":"RC"},{"code":"408923","type":"LOCAL"},{"code":"343895","type":"LOCAL"}],"standard_charges":[{"gross_charge":1765.76,"discounted_cash":618.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408923 = Hospital System Supply Identifier | 343895 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 6.5MM","code_information":[{"code":"Sx00-1147-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"411228","type":"LOCAL"},{"code":"461757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1765.76,"discounted_cash":618.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411228 = Hospital System Supply Identifier | 461757 = Lawson ID"}]},{"description":"PIN GDE CLUS","code_information":[{"code":"Sx00-1147-061","type":"CDM"},{"code":"272","type":"RC"},{"code":"408949","type":"LOCAL"},{"code":"343924","type":"LOCAL"}],"standard_charges":[{"gross_charge":5002.84,"discounted_cash":1750.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408949 = Hospital System Supply Identifier | 343924 = Lawson ID"}]},{"description":"FCP SCREW HLDING","code_information":[{"code":"Sx00-1147-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"408924","type":"LOCAL"},{"code":"343896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1379.66,"discounted_cash":482.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408924 = Hospital System Supply Identifier | 343896 = Lawson ID"}]},{"description":"WASHER CANN SCR 5.5-7.5MM 1.2","code_information":[{"code":"Sx00-1147-099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"721296","type":"LOCAL"},{"code":"732743","type":"LOCAL"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":53.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 721296 = Hospital System Supply Identifier | 732743 = Lawson ID"}]},{"description":"SCREW CANN MINI HERB 2.5X16MM","code_information":[{"code":"Sx00-1150-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"151048","type":"LOCAL"},{"code":"250825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1815.45,"discounted_cash":635.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 151048 = Hospital System Supply Identifier | 250825 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 12MM","code_information":[{"code":"Sx00-1152-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15450","type":"LOCAL"},{"code":"114304","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15450 = Hospital System Supply Identifier | 114304 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 14MM","code_information":[{"code":"Sx00-1152-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15451","type":"LOCAL"},{"code":"114305","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15451 = Hospital System Supply Identifier | 114305 = Lawson ID"}]},{"description":"DRILL TIP HERBERT DISP","code_information":[{"code":"Sx00-1152-015","type":"CDM"},{"code":"272","type":"RC"},{"code":"17319","type":"LOCAL"},{"code":"145717","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.75,"discounted_cash":280.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17319 = Hospital System Supply Identifier | 145717 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 16MM","code_information":[{"code":"Sx00-1152-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15452","type":"LOCAL"},{"code":"114306","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15452 = Hospital System Supply Identifier | 114306 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 20MM","code_information":[{"code":"Sx00-1152-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15453","type":"LOCAL"},{"code":"114307","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15453 = Hospital System Supply Identifier | 114307 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 22MM","code_information":[{"code":"Sx00-1152-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17599","type":"LOCAL"},{"code":"154038","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17599 = Hospital System Supply Identifier | 154038 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 24MM","code_information":[{"code":"Sx00-1152-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15454","type":"LOCAL"},{"code":"114309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15454 = Hospital System Supply Identifier | 114309 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 26MM","code_information":[{"code":"Sx00-1152-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15455","type":"LOCAL"},{"code":"114310","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15455 = Hospital System Supply Identifier | 114310 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 28MM","code_information":[{"code":"Sx00-1152-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15456","type":"LOCAL"},{"code":"114311","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15456 = Hospital System Supply Identifier | 114311 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 30MM","code_information":[{"code":"Sx00-1152-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"15457","type":"LOCAL"},{"code":"114312","type":"LOCAL"}],"standard_charges":[{"gross_charge":1715.39,"discounted_cash":600.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 15457 = Hospital System Supply Identifier | 114312 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 24H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408782","type":"LOCAL"},{"code":"339884","type":"LOCAL"}],"standard_charges":[{"gross_charge":2212.05,"discounted_cash":774.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408782 = Hospital System Supply Identifier | 339884 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 22H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408781","type":"LOCAL"},{"code":"339883","type":"LOCAL"}],"standard_charges":[{"gross_charge":1973.27,"discounted_cash":690.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408781 = Hospital System Supply Identifier | 339883 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 18H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408779","type":"LOCAL"},{"code":"339881","type":"LOCAL"}],"standard_charges":[{"gross_charge":1599.79,"discounted_cash":559.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408779 = Hospital System Supply Identifier | 339881 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 16H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408778","type":"LOCAL"},{"code":"339880","type":"LOCAL"}],"standard_charges":[{"gross_charge":1295.06,"discounted_cash":453.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408778 = Hospital System Supply Identifier | 339880 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 20H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408780","type":"LOCAL"},{"code":"339882","type":"LOCAL"}],"standard_charges":[{"gross_charge":1714.08,"discounted_cash":599.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408780 = Hospital System Supply Identifier | 339882 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 12H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408776","type":"LOCAL"},{"code":"339878","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408776 = Hospital System Supply Identifier | 339878 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 10H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408775","type":"LOCAL"},{"code":"339877","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408775 = Hospital System Supply Identifier | 339877 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 8H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408774","type":"LOCAL"},{"code":"339876","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408774 = Hospital System Supply Identifier | 339876 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 6H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408773","type":"LOCAL"},{"code":"339875","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408773 = Hospital System Supply Identifier | 339875 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 14H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408777","type":"LOCAL"},{"code":"339879","type":"LOCAL"}],"standard_charges":[{"gross_charge":1262.84,"discounted_cash":441.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408777 = Hospital System Supply Identifier | 339879 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-03","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407518","type":"LOCAL"},{"code":"201370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407518 = Hospital System Supply Identifier | 201370 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-02","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407531","type":"LOCAL"},{"code":"201833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407531 = Hospital System Supply Identifier | 201833 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-03","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407509","type":"LOCAL"},{"code":"200695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407509 = Hospital System Supply Identifier | 200695 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-02","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407542","type":"LOCAL"},{"code":"203357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407542 = Hospital System Supply Identifier | 203357 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-03","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407510","type":"LOCAL"},{"code":"201155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407510 = Hospital System Supply Identifier | 201155 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-02","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407543","type":"LOCAL"},{"code":"203361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407543 = Hospital System Supply Identifier | 203361 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-02","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407545","type":"LOCAL"},{"code":"204507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407545 = Hospital System Supply Identifier | 204507 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-03","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407511","type":"LOCAL"},{"code":"201175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407511 = Hospital System Supply Identifier | 201175 = Lawson ID"}]},{"description":"PLATE TUBE 150 1181-150-03","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407546","type":"LOCAL"},{"code":"204516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407546 = Hospital System Supply Identifier | 204516 = Lawson ID"}]},{"description":"PLATE SUPCNDYL TB 150 2H","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407530","type":"LOCAL"},{"code":"201531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1856.21,"discounted_cash":649.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407530 = Hospital System Supply Identifier | 201531 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 18GA","code_information":[{"code":"Sx00-1191-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"20912","type":"LOCAL"},{"code":"103817","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":17.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 20912 = Hospital System Supply Identifier | 103817 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 16GA","code_information":[{"code":"Sx00-1191-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"16374","type":"LOCAL"},{"code":"131618","type":"LOCAL"}],"standard_charges":[{"gross_charge":50.5,"discounted_cash":17.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 16374 = Hospital System Supply Identifier | 131618 = Lawson ID"}]},{"description":"PLATE DHS VRSAFX2 95D 16H","code_information":[{"code":"Sx00-1193-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410141","type":"LOCAL"},{"code":"410379","type":"LOCAL"}],"standard_charges":[{"gross_charge":2736.85,"discounted_cash":957.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410141 = Hospital System Supply Identifier | 410379 = Lawson ID"}]},{"description":"DISC - PUNCH ORTH TRAB","code_information":[{"code":"Sx00-1197-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"744077","type":"LOCAL"},{"code":"421234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1163.25,"discounted_cash":407.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 744077 = Hospital System Supply Identifier | 421234 = Lawson ID"}]},{"description":"ROD ORTH TRABCLR OSTNECROSIS","code_information":[{"code":"Sx00-1197-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408707","type":"LOCAL"},{"code":"339245","type":"LOCAL"}],"standard_charges":[{"gross_charge":16850.52,"discounted_cash":5897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408707 = Hospital System Supply Identifier | 339245 = Lawson ID"}]},{"description":"IMP HIP OSTEONECROSIS 10X90MM","code_information":[{"code":"Sx00-1197-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"171788","type":"LOCAL"},{"code":"439191","type":"LOCAL"}],"standard_charges":[{"gross_charge":16850.52,"discounted_cash":5897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 171788 = Hospital System Supply Identifier | 439191 = Lawson ID"}]},{"description":"IMP OSTEONECROSIS 10 X 95MM","code_information":[{"code":"Sx00-1197-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411206","type":"LOCAL"},{"code":"454951","type":"LOCAL"}],"standard_charges":[{"gross_charge":16850.52,"discounted_cash":5897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411206 = Hospital System Supply Identifier | 454951 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054607","type":"LOCAL"},{"code":"877057","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054607 = Hospital System Supply Identifier | 877057 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054608","type":"LOCAL"},{"code":"877058","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054608 = Hospital System Supply Identifier | 877058 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 25X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054606","type":"LOCAL"},{"code":"877056","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054606 = Hospital System Supply Identifier | 877056 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 25X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054609","type":"LOCAL"},{"code":"877059","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054609 = Hospital System Supply Identifier | 877059 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 30X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054610","type":"LOCAL"},{"code":"877060","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054610 = Hospital System Supply Identifier | 877060 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 35X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054611","type":"LOCAL"},{"code":"877061","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054611 = Hospital System Supply Identifier | 877061 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054612","type":"LOCAL"},{"code":"877062","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054612 = Hospital System Supply Identifier | 877062 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054613","type":"LOCAL"},{"code":"877063","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054613 = Hospital System Supply Identifier | 877063 = Lawson ID"}]},{"description":"BLADE PLATE 5MM X25MM 2H 90-DE","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"813192","type":"LOCAL"},{"code":"S298353","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 813192 = Hospital System Supply Identifier | S298353 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 50X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054619","type":"LOCAL"},{"code":"877069","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054619 = Hospital System Supply Identifier | 877069 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 60X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054621","type":"LOCAL"},{"code":"877071","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054621 = Hospital System Supply Identifier | 877071 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 55X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054620","type":"LOCAL"},{"code":"877070","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054620 = Hospital System Supply Identifier | 877070 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 45X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054618","type":"LOCAL"},{"code":"877068","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054618 = Hospital System Supply Identifier | 877068 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 40X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054617","type":"LOCAL"},{"code":"877067","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054617 = Hospital System Supply Identifier | 877067 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 35X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054616","type":"LOCAL"},{"code":"877066","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054616 = Hospital System Supply Identifier | 877066 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 30X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054615","type":"LOCAL"},{"code":"877065","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054615 = Hospital System Supply Identifier | 877065 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 25X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054614","type":"LOCAL"},{"code":"877064","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054614 = Hospital System Supply Identifier | 877064 = Lawson ID"}]},{"description":"PLATE BONE CANNULATED CHILD OSTEOTOMY 90 DEGREE 0012003005 6X50MM","code_information":[{"code":"Sx00-1200-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356811","type":"LOCAL"},{"code":"1082556","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356811 = Hospital System Supply Identifier | 1082556 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 40X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054630","type":"LOCAL"},{"code":"877080","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054630 = Hospital System Supply Identifier | 877080 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 35X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054629","type":"LOCAL"},{"code":"877079","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054629 = Hospital System Supply Identifier | 877079 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 30X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054628","type":"LOCAL"},{"code":"877078","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054628 = Hospital System Supply Identifier | 877078 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 25X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054627","type":"LOCAL"},{"code":"877077","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054627 = Hospital System Supply Identifier | 877077 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 50X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054626","type":"LOCAL"},{"code":"877076","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054626 = Hospital System Supply Identifier | 877076 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 45X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054625","type":"LOCAL"},{"code":"877075","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054625 = Hospital System Supply Identifier | 877075 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 35X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054624","type":"LOCAL"},{"code":"877074","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054624 = Hospital System Supply Identifier | 877074 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 30X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054623","type":"LOCAL"},{"code":"877073","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054623 = Hospital System Supply Identifier | 877073 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 25X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054622","type":"LOCAL"},{"code":"877072","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054622 = Hospital System Supply Identifier | 877072 = Lawson ID"}]},{"description":"PLATE 90DEG 40X6MM","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"918407","type":"LOCAL"},{"code":"711670","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 918407 = Hospital System Supply Identifier | 711670 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 45X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054631","type":"LOCAL"},{"code":"877081","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054631 = Hospital System Supply Identifier | 877081 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 50X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054632","type":"LOCAL"},{"code":"877082","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054632 = Hospital System Supply Identifier | 877082 = Lawson ID"}]},{"description":"PLATE BONE 25MM 100-DEG 3-HOLE","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"801298","type":"LOCAL"},{"code":"S299349","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 801298 = Hospital System Supply Identifier | S299349 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 45X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054636","type":"LOCAL"},{"code":"877086","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054636 = Hospital System Supply Identifier | 877086 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 50X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054637","type":"LOCAL"},{"code":"877087","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054637 = Hospital System Supply Identifier | 877087 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 35X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054634","type":"LOCAL"},{"code":"877084","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054634 = Hospital System Supply Identifier | 877084 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 30X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054633","type":"LOCAL"},{"code":"877083","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054633 = Hospital System Supply Identifier | 877083 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 40X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054635","type":"LOCAL"},{"code":"877085","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054635 = Hospital System Supply Identifier | 877085 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 40X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054638","type":"LOCAL"},{"code":"877088","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054638 = Hospital System Supply Identifier | 877088 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 45X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054639","type":"LOCAL"},{"code":"877089","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054639 = Hospital System Supply Identifier | 877089 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 50X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054640","type":"LOCAL"},{"code":"877090","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054640 = Hospital System Supply Identifier | 877090 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 55X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054641","type":"LOCAL"},{"code":"877091","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054641 = Hospital System Supply Identifier | 877091 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 60X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054642","type":"LOCAL"},{"code":"877092","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054642 = Hospital System Supply Identifier | 877092 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 65X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054643","type":"LOCAL"},{"code":"877093","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054643 = Hospital System Supply Identifier | 877093 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 70X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054644","type":"LOCAL"},{"code":"877094","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054644 = Hospital System Supply Identifier | 877094 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 65X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054650","type":"LOCAL"},{"code":"877100","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054650 = Hospital System Supply Identifier | 877100 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 60X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054649","type":"LOCAL"},{"code":"877099","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054649 = Hospital System Supply Identifier | 877099 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 55X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054648","type":"LOCAL"},{"code":"877098","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054648 = Hospital System Supply Identifier | 877098 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 40X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054645","type":"LOCAL"},{"code":"877095","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054645 = Hospital System Supply Identifier | 877095 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 45X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054646","type":"LOCAL"},{"code":"877096","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054646 = Hospital System Supply Identifier | 877096 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 50X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054647","type":"LOCAL"},{"code":"877097","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054647 = Hospital System Supply Identifier | 877097 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 70X14X4H","code_information":[{"code":"Sx00-1200-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054651","type":"LOCAL"},{"code":"877101","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054651 = Hospital System Supply Identifier | 877101 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 25X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054652","type":"LOCAL"},{"code":"877102","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054652 = Hospital System Supply Identifier | 877102 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 30X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054653","type":"LOCAL"},{"code":"877103","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054653 = Hospital System Supply Identifier | 877103 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 35X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054654","type":"LOCAL"},{"code":"877104","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054654 = Hospital System Supply Identifier | 877104 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 55X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054658","type":"LOCAL"},{"code":"877108","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054658 = Hospital System Supply Identifier | 877108 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 60X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054659","type":"LOCAL"},{"code":"877109","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054659 = Hospital System Supply Identifier | 877109 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 45X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054656","type":"LOCAL"},{"code":"877106","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054656 = Hospital System Supply Identifier | 877106 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 40X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054655","type":"LOCAL"},{"code":"877105","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054655 = Hospital System Supply Identifier | 877105 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 50X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054657","type":"LOCAL"},{"code":"877107","type":"LOCAL"}],"standard_charges":[{"gross_charge":7200.76,"discounted_cash":2520.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054657 = Hospital System Supply Identifier | 877107 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006003 6X55MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356879","type":"LOCAL"},{"code":"1082448","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356879 = Hospital System Supply Identifier | 1082448 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006004 6X60MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356428","type":"LOCAL"},{"code":"1082464","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356428 = Hospital System Supply Identifier | 1082464 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006002 6X50MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356947","type":"LOCAL"},{"code":"1082483","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356947 = Hospital System Supply Identifier | 1082483 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006006 6X70MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357050","type":"LOCAL"},{"code":"1082534","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357050 = Hospital System Supply Identifier | 1082534 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006005 6X65MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356584","type":"LOCAL"},{"code":"1082547","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356584 = Hospital System Supply Identifier | 1082547 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006001 6X45MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356812","type":"LOCAL"},{"code":"1082571","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356812 = Hospital System Supply Identifier | 1082571 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006000 6X40MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356813","type":"LOCAL"},{"code":"1082574","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356813 = Hospital System Supply Identifier | 1082574 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 80X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054667","type":"LOCAL"},{"code":"877117","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054667 = Hospital System Supply Identifier | 877117 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 75X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054666","type":"LOCAL"},{"code":"877116","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054666 = Hospital System Supply Identifier | 877116 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 70X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054665","type":"LOCAL"},{"code":"877115","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054665 = Hospital System Supply Identifier | 877115 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 65X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054664","type":"LOCAL"},{"code":"877114","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054664 = Hospital System Supply Identifier | 877114 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 45X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054660","type":"LOCAL"},{"code":"877110","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054660 = Hospital System Supply Identifier | 877110 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 55X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054662","type":"LOCAL"},{"code":"877112","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054662 = Hospital System Supply Identifier | 877112 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 50X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054661","type":"LOCAL"},{"code":"877111","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054661 = Hospital System Supply Identifier | 877111 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 60X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054663","type":"LOCAL"},{"code":"877113","type":"LOCAL"}],"standard_charges":[{"gross_charge":7387.38,"discounted_cash":2585.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054663 = Hospital System Supply Identifier | 877113 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 60X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054672","type":"LOCAL"},{"code":"877122","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054672 = Hospital System Supply Identifier | 877122 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 65X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054673","type":"LOCAL"},{"code":"877123","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054673 = Hospital System Supply Identifier | 877123 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 55X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054671","type":"LOCAL"},{"code":"877121","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054671 = Hospital System Supply Identifier | 877121 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 45X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054669","type":"LOCAL"},{"code":"877119","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054669 = Hospital System Supply Identifier | 877119 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 40X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054668","type":"LOCAL"},{"code":"877118","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054668 = Hospital System Supply Identifier | 877118 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 50X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054670","type":"LOCAL"},{"code":"877120","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054670 = Hospital System Supply Identifier | 877120 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 70X10 4H","code_information":[{"code":"Sx00-1200-805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054674","type":"LOCAL"},{"code":"877124","type":"LOCAL"}],"standard_charges":[{"gross_charge":7832.0,"discounted_cash":2741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054674 = Hospital System Supply Identifier | 877124 = Lawson ID"}]},{"description":"SPLINT THOMAS LEG LG 45X9IN","code_information":[{"code":"Sx00-1232-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"393041","type":"LOCAL"},{"code":"449215","type":"LOCAL"}],"standard_charges":[{"gross_charge":794.2,"discounted_cash":277.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 393041 = Hospital System Supply Identifier | 449215 = Lawson ID"}]},{"description":"SPLINT THOMAS RADLUC LG","code_information":[{"code":"Sx00-1232-008","type":"CDM"},{"code":"272","type":"RC"},{"code":"393042","type":"LOCAL"},{"code":"449216","type":"LOCAL"}],"standard_charges":[{"gross_charge":2114.84,"discounted_cash":740.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 393042 = Hospital System Supply Identifier | 449216 = Lawson ID"}]},{"description":"SPLINT PEARSON ATTACH LG 29IN","code_information":[{"code":"Sx00-1232-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"393039","type":"LOCAL"},{"code":"449213","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 393039 = Hospital System Supply Identifier | 449213 = Lawson ID"}]},{"description":"BIT DRILL FIXATION LONG 6.4MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"743293","type":"LOCAL"},{"code":"303894","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.25,"discounted_cash":87.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 743293 = Hospital System Supply Identifier | 303894 = Lawson ID"}]},{"description":"BIT DRILIL SHANK 6.4X203MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"411112","type":"LOCAL"},{"code":"437851","type":"LOCAL"}],"standard_charges":[{"gross_charge":827.4,"discounted_cash":289.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411112 = Hospital System Supply Identifier | 437851 = Lawson ID"}]},{"description":"WIRE SPN LUQUE 16GA","code_information":[{"code":"Sx00-1292-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176560","type":"LOCAL"},{"code":"217910","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":74.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 176560 = Hospital System Supply Identifier | 217910 = Lawson ID"}]},{"description":"DISC - WIRE SPN LUQUE 18GA","code_information":[{"code":"Sx00-1292-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"176561","type":"LOCAL"},{"code":"217911","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.1,"discounted_cash":74.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 176561 = Hospital System Supply Identifier | 217911 = Lawson ID"}]},{"description":"SCREW WASHER CANN 2.5/3.0","code_information":[{"code":"Sx00-1400-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054675","type":"LOCAL"},{"code":"877125","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.15,"discounted_cash":40.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054675 = Hospital System Supply Identifier | 877125 = Lawson ID"}]},{"description":"SCREW WASHER CANN 3.5/4.0","code_information":[{"code":"Sx00-1400-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054676","type":"LOCAL"},{"code":"877126","type":"LOCAL"}],"standard_charges":[{"gross_charge":116.15,"discounted_cash":40.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054676 = Hospital System Supply Identifier | 877126 = Lawson ID"}]},{"description":"SCREW WASHER CANN 4.5","code_information":[{"code":"Sx00-1400-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054677","type":"LOCAL"},{"code":"877127","type":"LOCAL"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054677 = Hospital System Supply Identifier | 877127 = Lawson ID"}]},{"description":"SCREW WASHER CANN 5.5","code_information":[{"code":"Sx00-1400-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054678","type":"LOCAL"},{"code":"877128","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054678 = Hospital System Supply Identifier | 877128 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X8MM","code_information":[{"code":"Sx00-1400-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054679","type":"LOCAL"},{"code":"877129","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054679 = Hospital System Supply Identifier | 877129 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X16MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054683","type":"LOCAL"},{"code":"877133","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054683 = Hospital System Supply Identifier | 877133 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X14MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054682","type":"LOCAL"},{"code":"877132","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054682 = Hospital System Supply Identifier | 877132 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X18MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054684","type":"LOCAL"},{"code":"877134","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054684 = Hospital System Supply Identifier | 877134 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X10MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054680","type":"LOCAL"},{"code":"877130","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054680 = Hospital System Supply Identifier | 877130 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X12MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054681","type":"LOCAL"},{"code":"877131","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054681 = Hospital System Supply Identifier | 877131 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X20MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054685","type":"LOCAL"},{"code":"877135","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054685 = Hospital System Supply Identifier | 877135 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X22MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054686","type":"LOCAL"},{"code":"877136","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054686 = Hospital System Supply Identifier | 877136 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X24MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054687","type":"LOCAL"},{"code":"877137","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054687 = Hospital System Supply Identifier | 877137 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X26MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054688","type":"LOCAL"},{"code":"877138","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054688 = Hospital System Supply Identifier | 877138 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X28MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054689","type":"LOCAL"},{"code":"877139","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054689 = Hospital System Supply Identifier | 877139 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X30MM","code_information":[{"code":"Sx00-1400-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054690","type":"LOCAL"},{"code":"877140","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054690 = Hospital System Supply Identifier | 877140 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054695","type":"LOCAL"},{"code":"877145","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054695 = Hospital System Supply Identifier | 877145 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X14MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054693","type":"LOCAL"},{"code":"877143","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054693 = Hospital System Supply Identifier | 877143 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054694","type":"LOCAL"},{"code":"877144","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054694 = Hospital System Supply Identifier | 877144 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X10MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054691","type":"LOCAL"},{"code":"877141","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054691 = Hospital System Supply Identifier | 877141 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X12MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054692","type":"LOCAL"},{"code":"877142","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054692 = Hospital System Supply Identifier | 877142 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054696","type":"LOCAL"},{"code":"877146","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054696 = Hospital System Supply Identifier | 877146 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054697","type":"LOCAL"},{"code":"877147","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054697 = Hospital System Supply Identifier | 877147 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054698","type":"LOCAL"},{"code":"877148","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054698 = Hospital System Supply Identifier | 877148 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054699","type":"LOCAL"},{"code":"877149","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054699 = Hospital System Supply Identifier | 877149 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054700","type":"LOCAL"},{"code":"877150","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054700 = Hospital System Supply Identifier | 877150 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054701","type":"LOCAL"},{"code":"877151","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054701 = Hospital System Supply Identifier | 877151 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054702","type":"LOCAL"},{"code":"877152","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054702 = Hospital System Supply Identifier | 877152 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054703","type":"LOCAL"},{"code":"877153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054703 = Hospital System Supply Identifier | 877153 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054708","type":"LOCAL"},{"code":"877158","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054708 = Hospital System Supply Identifier | 877158 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054707","type":"LOCAL"},{"code":"877157","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054707 = Hospital System Supply Identifier | 877157 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054704","type":"LOCAL"},{"code":"877154","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054704 = Hospital System Supply Identifier | 877154 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054705","type":"LOCAL"},{"code":"877155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054705 = Hospital System Supply Identifier | 877155 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054706","type":"LOCAL"},{"code":"877156","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054706 = Hospital System Supply Identifier | 877156 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054709","type":"LOCAL"},{"code":"877159","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054709 = Hospital System Supply Identifier | 877159 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X8MM","code_information":[{"code":"Sx00-1400-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054710","type":"LOCAL"},{"code":"877160","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054710 = Hospital System Supply Identifier | 877160 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X10MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054711","type":"LOCAL"},{"code":"877161","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054711 = Hospital System Supply Identifier | 877161 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X12MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054712","type":"LOCAL"},{"code":"877162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054712 = Hospital System Supply Identifier | 877162 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054713","type":"LOCAL"},{"code":"877163","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054713 = Hospital System Supply Identifier | 877163 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054714","type":"LOCAL"},{"code":"877164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054714 = Hospital System Supply Identifier | 877164 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054715","type":"LOCAL"},{"code":"877165","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054715 = Hospital System Supply Identifier | 877165 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054720","type":"LOCAL"},{"code":"877170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054720 = Hospital System Supply Identifier | 877170 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054719","type":"LOCAL"},{"code":"877169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054719 = Hospital System Supply Identifier | 877169 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054716","type":"LOCAL"},{"code":"877166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054716 = Hospital System Supply Identifier | 877166 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054717","type":"LOCAL"},{"code":"877167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054717 = Hospital System Supply Identifier | 877167 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054718","type":"LOCAL"},{"code":"877168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054718 = Hospital System Supply Identifier | 877168 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054724","type":"LOCAL"},{"code":"877174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054724 = Hospital System Supply Identifier | 877174 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054721","type":"LOCAL"},{"code":"877171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054721 = Hospital System Supply Identifier | 877171 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054722","type":"LOCAL"},{"code":"877172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054722 = Hospital System Supply Identifier | 877172 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054723","type":"LOCAL"},{"code":"877173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054723 = Hospital System Supply Identifier | 877173 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054725","type":"LOCAL"},{"code":"877175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054725 = Hospital System Supply Identifier | 877175 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054727","type":"LOCAL"},{"code":"877177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054727 = Hospital System Supply Identifier | 877177 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054726","type":"LOCAL"},{"code":"877176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054726 = Hospital System Supply Identifier | 877176 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1400-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054728","type":"LOCAL"},{"code":"877178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054728 = Hospital System Supply Identifier | 877178 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054729","type":"LOCAL"},{"code":"877179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054729 = Hospital System Supply Identifier | 877179 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054730","type":"LOCAL"},{"code":"877180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054730 = Hospital System Supply Identifier | 877180 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054731","type":"LOCAL"},{"code":"877181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054731 = Hospital System Supply Identifier | 877181 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054732","type":"LOCAL"},{"code":"877182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054732 = Hospital System Supply Identifier | 877182 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054733","type":"LOCAL"},{"code":"877183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054733 = Hospital System Supply Identifier | 877183 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054734","type":"LOCAL"},{"code":"877184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054734 = Hospital System Supply Identifier | 877184 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054735","type":"LOCAL"},{"code":"877185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054735 = Hospital System Supply Identifier | 877185 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054740","type":"LOCAL"},{"code":"877190","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054740 = Hospital System Supply Identifier | 877190 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054739","type":"LOCAL"},{"code":"877189","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054739 = Hospital System Supply Identifier | 877189 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054736","type":"LOCAL"},{"code":"877186","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054736 = Hospital System Supply Identifier | 877186 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054737","type":"LOCAL"},{"code":"877187","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054737 = Hospital System Supply Identifier | 877187 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054738","type":"LOCAL"},{"code":"877188","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054738 = Hospital System Supply Identifier | 877188 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054741","type":"LOCAL"},{"code":"877191","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054741 = Hospital System Supply Identifier | 877191 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054742","type":"LOCAL"},{"code":"877192","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054742 = Hospital System Supply Identifier | 877192 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054743","type":"LOCAL"},{"code":"877193","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054743 = Hospital System Supply Identifier | 877193 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054747","type":"LOCAL"},{"code":"877197","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054747 = Hospital System Supply Identifier | 877197 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X14MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054746","type":"LOCAL"},{"code":"877196","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054746 = Hospital System Supply Identifier | 877196 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054748","type":"LOCAL"},{"code":"877198","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054748 = Hospital System Supply Identifier | 877198 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X10MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054744","type":"LOCAL"},{"code":"877194","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054744 = Hospital System Supply Identifier | 877194 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X12MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054745","type":"LOCAL"},{"code":"877195","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054745 = Hospital System Supply Identifier | 877195 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054749","type":"LOCAL"},{"code":"877199","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054749 = Hospital System Supply Identifier | 877199 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054750","type":"LOCAL"},{"code":"877200","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054750 = Hospital System Supply Identifier | 877200 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054751","type":"LOCAL"},{"code":"877201","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054751 = Hospital System Supply Identifier | 877201 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054752","type":"LOCAL"},{"code":"877202","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054752 = Hospital System Supply Identifier | 877202 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054753","type":"LOCAL"},{"code":"877203","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054753 = Hospital System Supply Identifier | 877203 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054757","type":"LOCAL"},{"code":"877207","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054757 = Hospital System Supply Identifier | 877207 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054756","type":"LOCAL"},{"code":"877206","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054756 = Hospital System Supply Identifier | 877206 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054758","type":"LOCAL"},{"code":"877208","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054758 = Hospital System Supply Identifier | 877208 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054754","type":"LOCAL"},{"code":"877204","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054754 = Hospital System Supply Identifier | 877204 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054755","type":"LOCAL"},{"code":"877205","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054755 = Hospital System Supply Identifier | 877205 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054759","type":"LOCAL"},{"code":"877209","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054759 = Hospital System Supply Identifier | 877209 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054760","type":"LOCAL"},{"code":"877210","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054760 = Hospital System Supply Identifier | 877210 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054761","type":"LOCAL"},{"code":"877211","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054761 = Hospital System Supply Identifier | 877211 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054762","type":"LOCAL"},{"code":"877212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054762 = Hospital System Supply Identifier | 877212 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054763","type":"LOCAL"},{"code":"877213","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054763 = Hospital System Supply Identifier | 877213 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054764","type":"LOCAL"},{"code":"877214","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054764 = Hospital System Supply Identifier | 877214 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054765","type":"LOCAL"},{"code":"877215","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054765 = Hospital System Supply Identifier | 877215 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054766","type":"LOCAL"},{"code":"877216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054766 = Hospital System Supply Identifier | 877216 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054770","type":"LOCAL"},{"code":"877220","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054770 = Hospital System Supply Identifier | 877220 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054771","type":"LOCAL"},{"code":"877221","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054771 = Hospital System Supply Identifier | 877221 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054769","type":"LOCAL"},{"code":"877219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054769 = Hospital System Supply Identifier | 877219 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054768","type":"LOCAL"},{"code":"877218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054768 = Hospital System Supply Identifier | 877218 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054767","type":"LOCAL"},{"code":"877217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054767 = Hospital System Supply Identifier | 877217 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054772","type":"LOCAL"},{"code":"877222","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054772 = Hospital System Supply Identifier | 877222 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054773","type":"LOCAL"},{"code":"877223","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054773 = Hospital System Supply Identifier | 877223 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054774","type":"LOCAL"},{"code":"877224","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054774 = Hospital System Supply Identifier | 877224 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054775","type":"LOCAL"},{"code":"877225","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054775 = Hospital System Supply Identifier | 877225 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054776","type":"LOCAL"},{"code":"877226","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054776 = Hospital System Supply Identifier | 877226 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054781","type":"LOCAL"},{"code":"877231","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054781 = Hospital System Supply Identifier | 877231 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054780","type":"LOCAL"},{"code":"877230","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054780 = Hospital System Supply Identifier | 877230 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054779","type":"LOCAL"},{"code":"877229","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054779 = Hospital System Supply Identifier | 877229 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054778","type":"LOCAL"},{"code":"877228","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054778 = Hospital System Supply Identifier | 877228 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054777","type":"LOCAL"},{"code":"877227","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054777 = Hospital System Supply Identifier | 877227 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054782","type":"LOCAL"},{"code":"877232","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054782 = Hospital System Supply Identifier | 877232 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054783","type":"LOCAL"},{"code":"877233","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054783 = Hospital System Supply Identifier | 877233 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054784","type":"LOCAL"},{"code":"877234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054784 = Hospital System Supply Identifier | 877234 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054785","type":"LOCAL"},{"code":"877235","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054785 = Hospital System Supply Identifier | 877235 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054786","type":"LOCAL"},{"code":"877236","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054786 = Hospital System Supply Identifier | 877236 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054791","type":"LOCAL"},{"code":"877241","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054791 = Hospital System Supply Identifier | 877241 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054789","type":"LOCAL"},{"code":"877239","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054789 = Hospital System Supply Identifier | 877239 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054790","type":"LOCAL"},{"code":"877240","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054790 = Hospital System Supply Identifier | 877240 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054787","type":"LOCAL"},{"code":"877237","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054787 = Hospital System Supply Identifier | 877237 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054788","type":"LOCAL"},{"code":"877238","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054788 = Hospital System Supply Identifier | 877238 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054792","type":"LOCAL"},{"code":"877242","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054792 = Hospital System Supply Identifier | 877242 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054793","type":"LOCAL"},{"code":"877243","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054793 = Hospital System Supply Identifier | 877243 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054794","type":"LOCAL"},{"code":"877244","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054794 = Hospital System Supply Identifier | 877244 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054795","type":"LOCAL"},{"code":"877245","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054795 = Hospital System Supply Identifier | 877245 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054796","type":"LOCAL"},{"code":"877246","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054796 = Hospital System Supply Identifier | 877246 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054799","type":"LOCAL"},{"code":"877249","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054799 = Hospital System Supply Identifier | 877249 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054797","type":"LOCAL"},{"code":"877247","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054797 = Hospital System Supply Identifier | 877247 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054798","type":"LOCAL"},{"code":"877248","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054798 = Hospital System Supply Identifier | 877248 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054800","type":"LOCAL"},{"code":"877250","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054800 = Hospital System Supply Identifier | 877250 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054801","type":"LOCAL"},{"code":"877251","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054801 = Hospital System Supply Identifier | 877251 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054802","type":"LOCAL"},{"code":"877252","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054802 = Hospital System Supply Identifier | 877252 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054803","type":"LOCAL"},{"code":"877253","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054803 = Hospital System Supply Identifier | 877253 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054804","type":"LOCAL"},{"code":"877254","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054804 = Hospital System Supply Identifier | 877254 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054807","type":"LOCAL"},{"code":"877257","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054807 = Hospital System Supply Identifier | 877257 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054808","type":"LOCAL"},{"code":"877258","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054808 = Hospital System Supply Identifier | 877258 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054805","type":"LOCAL"},{"code":"877255","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054805 = Hospital System Supply Identifier | 877255 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054806","type":"LOCAL"},{"code":"877256","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054806 = Hospital System Supply Identifier | 877256 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054809","type":"LOCAL"},{"code":"877259","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054809 = Hospital System Supply Identifier | 877259 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054814","type":"LOCAL"},{"code":"877264","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054814 = Hospital System Supply Identifier | 877264 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054812","type":"LOCAL"},{"code":"877262","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054812 = Hospital System Supply Identifier | 877262 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054813","type":"LOCAL"},{"code":"877263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054813 = Hospital System Supply Identifier | 877263 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054811","type":"LOCAL"},{"code":"877261","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054811 = Hospital System Supply Identifier | 877261 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054810","type":"LOCAL"},{"code":"877260","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054810 = Hospital System Supply Identifier | 877260 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054815","type":"LOCAL"},{"code":"877265","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054815 = Hospital System Supply Identifier | 877265 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054816","type":"LOCAL"},{"code":"877266","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054816 = Hospital System Supply Identifier | 877266 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054817","type":"LOCAL"},{"code":"877267","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054817 = Hospital System Supply Identifier | 877267 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054818","type":"LOCAL"},{"code":"877268","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054818 = Hospital System Supply Identifier | 877268 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054819","type":"LOCAL"},{"code":"877269","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054819 = Hospital System Supply Identifier | 877269 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054824","type":"LOCAL"},{"code":"877274","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054824 = Hospital System Supply Identifier | 877274 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054822","type":"LOCAL"},{"code":"877272","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054822 = Hospital System Supply Identifier | 877272 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054823","type":"LOCAL"},{"code":"877273","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054823 = Hospital System Supply Identifier | 877273 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054820","type":"LOCAL"},{"code":"877270","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054820 = Hospital System Supply Identifier | 877270 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054821","type":"LOCAL"},{"code":"877271","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054821 = Hospital System Supply Identifier | 877271 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054825","type":"LOCAL"},{"code":"877275","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054825 = Hospital System Supply Identifier | 877275 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054826","type":"LOCAL"},{"code":"877276","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054826 = Hospital System Supply Identifier | 877276 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054827","type":"LOCAL"},{"code":"877277","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054827 = Hospital System Supply Identifier | 877277 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054828","type":"LOCAL"},{"code":"877278","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054828 = Hospital System Supply Identifier | 877278 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054829","type":"LOCAL"},{"code":"877279","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054829 = Hospital System Supply Identifier | 877279 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X14MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054830","type":"LOCAL"},{"code":"877280","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054830 = Hospital System Supply Identifier | 877280 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054831","type":"LOCAL"},{"code":"877281","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054831 = Hospital System Supply Identifier | 877281 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054832","type":"LOCAL"},{"code":"877282","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054832 = Hospital System Supply Identifier | 877282 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054837","type":"LOCAL"},{"code":"877287","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054837 = Hospital System Supply Identifier | 877287 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054836","type":"LOCAL"},{"code":"877286","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054836 = Hospital System Supply Identifier | 877286 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054833","type":"LOCAL"},{"code":"877283","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054833 = Hospital System Supply Identifier | 877283 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054834","type":"LOCAL"},{"code":"877284","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054834 = Hospital System Supply Identifier | 877284 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054835","type":"LOCAL"},{"code":"877285","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054835 = Hospital System Supply Identifier | 877285 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054838","type":"LOCAL"},{"code":"877288","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054838 = Hospital System Supply Identifier | 877288 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054839","type":"LOCAL"},{"code":"877289","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054839 = Hospital System Supply Identifier | 877289 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054840","type":"LOCAL"},{"code":"877290","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054840 = Hospital System Supply Identifier | 877290 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054841","type":"LOCAL"},{"code":"877291","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054841 = Hospital System Supply Identifier | 877291 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054842","type":"LOCAL"},{"code":"877292","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054842 = Hospital System Supply Identifier | 877292 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054847","type":"LOCAL"},{"code":"877297","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054847 = Hospital System Supply Identifier | 877297 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054846","type":"LOCAL"},{"code":"877296","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054846 = Hospital System Supply Identifier | 877296 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054845","type":"LOCAL"},{"code":"877295","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054845 = Hospital System Supply Identifier | 877295 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054843","type":"LOCAL"},{"code":"877293","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054843 = Hospital System Supply Identifier | 877293 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054844","type":"LOCAL"},{"code":"877294","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054844 = Hospital System Supply Identifier | 877294 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054848","type":"LOCAL"},{"code":"877298","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054848 = Hospital System Supply Identifier | 877298 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054849","type":"LOCAL"},{"code":"877299","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054849 = Hospital System Supply Identifier | 877299 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054850","type":"LOCAL"},{"code":"877300","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054850 = Hospital System Supply Identifier | 877300 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054851","type":"LOCAL"},{"code":"877301","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054851 = Hospital System Supply Identifier | 877301 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054852","type":"LOCAL"},{"code":"877302","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054852 = Hospital System Supply Identifier | 877302 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054853","type":"LOCAL"},{"code":"877303","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054853 = Hospital System Supply Identifier | 877303 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054854","type":"LOCAL"},{"code":"877304","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054854 = Hospital System Supply Identifier | 877304 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054855","type":"LOCAL"},{"code":"877305","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054855 = Hospital System Supply Identifier | 877305 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054856","type":"LOCAL"},{"code":"877306","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054856 = Hospital System Supply Identifier | 877306 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054857","type":"LOCAL"},{"code":"877307","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054857 = Hospital System Supply Identifier | 877307 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054858","type":"LOCAL"},{"code":"877308","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054858 = Hospital System Supply Identifier | 877308 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054859","type":"LOCAL"},{"code":"877309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054859 = Hospital System Supply Identifier | 877309 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054860","type":"LOCAL"},{"code":"877310","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054860 = Hospital System Supply Identifier | 877310 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054861","type":"LOCAL"},{"code":"877311","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054861 = Hospital System Supply Identifier | 877311 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054862","type":"LOCAL"},{"code":"877312","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054862 = Hospital System Supply Identifier | 877312 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054867","type":"LOCAL"},{"code":"877317","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054867 = Hospital System Supply Identifier | 877317 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054866","type":"LOCAL"},{"code":"877316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054866 = Hospital System Supply Identifier | 877316 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054865","type":"LOCAL"},{"code":"877315","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054865 = Hospital System Supply Identifier | 877315 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054864","type":"LOCAL"},{"code":"877314","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054864 = Hospital System Supply Identifier | 877314 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054863","type":"LOCAL"},{"code":"877313","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054863 = Hospital System Supply Identifier | 877313 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054868","type":"LOCAL"},{"code":"877318","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054868 = Hospital System Supply Identifier | 877318 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054869","type":"LOCAL"},{"code":"877319","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054869 = Hospital System Supply Identifier | 877319 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054870","type":"LOCAL"},{"code":"877320","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054870 = Hospital System Supply Identifier | 877320 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054871","type":"LOCAL"},{"code":"877321","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054871 = Hospital System Supply Identifier | 877321 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054872","type":"LOCAL"},{"code":"877322","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054872 = Hospital System Supply Identifier | 877322 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054877","type":"LOCAL"},{"code":"877327","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054877 = Hospital System Supply Identifier | 877327 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054875","type":"LOCAL"},{"code":"877325","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054875 = Hospital System Supply Identifier | 877325 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054876","type":"LOCAL"},{"code":"877326","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054876 = Hospital System Supply Identifier | 877326 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054873","type":"LOCAL"},{"code":"877323","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054873 = Hospital System Supply Identifier | 877323 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054874","type":"LOCAL"},{"code":"877324","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054874 = Hospital System Supply Identifier | 877324 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054878","type":"LOCAL"},{"code":"877328","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054878 = Hospital System Supply Identifier | 877328 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054879","type":"LOCAL"},{"code":"877329","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054879 = Hospital System Supply Identifier | 877329 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054880","type":"LOCAL"},{"code":"877330","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054880 = Hospital System Supply Identifier | 877330 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054884","type":"LOCAL"},{"code":"877334","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054884 = Hospital System Supply Identifier | 877334 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED SHORT-THREAD STERILE","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357223","type":"LOCAL"},{"code":"1083674","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357223 = Hospital System Supply Identifier | 1083674 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054881","type":"LOCAL"},{"code":"877331","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054881 = Hospital System Supply Identifier | 877331 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054882","type":"LOCAL"},{"code":"877332","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054882 = Hospital System Supply Identifier | 877332 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054883","type":"LOCAL"},{"code":"877333","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054883 = Hospital System Supply Identifier | 877333 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054889","type":"LOCAL"},{"code":"877339","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054889 = Hospital System Supply Identifier | 877339 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054888","type":"LOCAL"},{"code":"877338","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054888 = Hospital System Supply Identifier | 877338 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054885","type":"LOCAL"},{"code":"877335","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054885 = Hospital System Supply Identifier | 877335 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054886","type":"LOCAL"},{"code":"877336","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054886 = Hospital System Supply Identifier | 877336 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054887","type":"LOCAL"},{"code":"877337","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054887 = Hospital System Supply Identifier | 877337 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054893","type":"LOCAL"},{"code":"877343","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054893 = Hospital System Supply Identifier | 877343 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054890","type":"LOCAL"},{"code":"877340","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054890 = Hospital System Supply Identifier | 877340 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054891","type":"LOCAL"},{"code":"877341","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054891 = Hospital System Supply Identifier | 877341 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054892","type":"LOCAL"},{"code":"877342","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054892 = Hospital System Supply Identifier | 877342 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054894","type":"LOCAL"},{"code":"877344","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054894 = Hospital System Supply Identifier | 877344 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054899","type":"LOCAL"},{"code":"877349","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054899 = Hospital System Supply Identifier | 877349 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054898","type":"LOCAL"},{"code":"877348","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054898 = Hospital System Supply Identifier | 877348 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054896","type":"LOCAL"},{"code":"877346","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054896 = Hospital System Supply Identifier | 877346 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054897","type":"LOCAL"},{"code":"877347","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054897 = Hospital System Supply Identifier | 877347 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054895","type":"LOCAL"},{"code":"877345","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054895 = Hospital System Supply Identifier | 877345 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054900","type":"LOCAL"},{"code":"877350","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054900 = Hospital System Supply Identifier | 877350 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054901","type":"LOCAL"},{"code":"877351","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054901 = Hospital System Supply Identifier | 877351 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054902","type":"LOCAL"},{"code":"877352","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054902 = Hospital System Supply Identifier | 877352 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054903","type":"LOCAL"},{"code":"877353","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054903 = Hospital System Supply Identifier | 877353 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054904","type":"LOCAL"},{"code":"877354","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054904 = Hospital System Supply Identifier | 877354 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054905","type":"LOCAL"},{"code":"877355","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054905 = Hospital System Supply Identifier | 877355 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054906","type":"LOCAL"},{"code":"877356","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054906 = Hospital System Supply Identifier | 877356 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054907","type":"LOCAL"},{"code":"877357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":450.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054907 = Hospital System Supply Identifier | 877357 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X14MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054908","type":"LOCAL"},{"code":"877358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054908 = Hospital System Supply Identifier | 877358 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054909","type":"LOCAL"},{"code":"877359","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054909 = Hospital System Supply Identifier | 877359 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054910","type":"LOCAL"},{"code":"877360","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054910 = Hospital System Supply Identifier | 877360 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054911","type":"LOCAL"},{"code":"877361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054911 = Hospital System Supply Identifier | 877361 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054912","type":"LOCAL"},{"code":"877362","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054912 = Hospital System Supply Identifier | 877362 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054913","type":"LOCAL"},{"code":"877363","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054913 = Hospital System Supply Identifier | 877363 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054914","type":"LOCAL"},{"code":"877364","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054914 = Hospital System Supply Identifier | 877364 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054915","type":"LOCAL"},{"code":"877365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054915 = Hospital System Supply Identifier | 877365 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054920","type":"LOCAL"},{"code":"877370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054920 = Hospital System Supply Identifier | 877370 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054919","type":"LOCAL"},{"code":"877369","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054919 = Hospital System Supply Identifier | 877369 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054917","type":"LOCAL"},{"code":"877367","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054917 = Hospital System Supply Identifier | 877367 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054916","type":"LOCAL"},{"code":"877366","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054916 = Hospital System Supply Identifier | 877366 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054918","type":"LOCAL"},{"code":"877368","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054918 = Hospital System Supply Identifier | 877368 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054921","type":"LOCAL"},{"code":"877371","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054921 = Hospital System Supply Identifier | 877371 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054922","type":"LOCAL"},{"code":"877372","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054922 = Hospital System Supply Identifier | 877372 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054923","type":"LOCAL"},{"code":"877373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054923 = Hospital System Supply Identifier | 877373 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054924","type":"LOCAL"},{"code":"877374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054924 = Hospital System Supply Identifier | 877374 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054925","type":"LOCAL"},{"code":"877375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054925 = Hospital System Supply Identifier | 877375 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054927","type":"LOCAL"},{"code":"877377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054927 = Hospital System Supply Identifier | 877377 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054926","type":"LOCAL"},{"code":"877376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054926 = Hospital System Supply Identifier | 877376 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054928","type":"LOCAL"},{"code":"877378","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054928 = Hospital System Supply Identifier | 877378 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054929","type":"LOCAL"},{"code":"877379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054929 = Hospital System Supply Identifier | 877379 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054930","type":"LOCAL"},{"code":"877380","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054930 = Hospital System Supply Identifier | 877380 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054931","type":"LOCAL"},{"code":"877381","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054931 = Hospital System Supply Identifier | 877381 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054932","type":"LOCAL"},{"code":"877382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054932 = Hospital System Supply Identifier | 877382 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054933","type":"LOCAL"},{"code":"877383","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054933 = Hospital System Supply Identifier | 877383 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054934","type":"LOCAL"},{"code":"877384","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054934 = Hospital System Supply Identifier | 877384 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054935","type":"LOCAL"},{"code":"877385","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054935 = Hospital System Supply Identifier | 877385 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054938","type":"LOCAL"},{"code":"877388","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054938 = Hospital System Supply Identifier | 877388 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054937","type":"LOCAL"},{"code":"877387","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054937 = Hospital System Supply Identifier | 877387 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054936","type":"LOCAL"},{"code":"877386","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054936 = Hospital System Supply Identifier | 877386 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054943","type":"LOCAL"},{"code":"877393","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054943 = Hospital System Supply Identifier | 877393 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054942","type":"LOCAL"},{"code":"877392","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054942 = Hospital System Supply Identifier | 877392 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054939","type":"LOCAL"},{"code":"877389","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054939 = Hospital System Supply Identifier | 877389 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054940","type":"LOCAL"},{"code":"877390","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054940 = Hospital System Supply Identifier | 877390 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054941","type":"LOCAL"},{"code":"877391","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054941 = Hospital System Supply Identifier | 877391 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054944","type":"LOCAL"},{"code":"877394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054944 = Hospital System Supply Identifier | 877394 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054945","type":"LOCAL"},{"code":"877395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054945 = Hospital System Supply Identifier | 877395 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054946","type":"LOCAL"},{"code":"877396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054946 = Hospital System Supply Identifier | 877396 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054947","type":"LOCAL"},{"code":"877397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054947 = Hospital System Supply Identifier | 877397 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054948","type":"LOCAL"},{"code":"877398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054948 = Hospital System Supply Identifier | 877398 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054949","type":"LOCAL"},{"code":"877399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054949 = Hospital System Supply Identifier | 877399 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054951","type":"LOCAL"},{"code":"877401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054951 = Hospital System Supply Identifier | 877401 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054952","type":"LOCAL"},{"code":"877402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054952 = Hospital System Supply Identifier | 877402 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054953","type":"LOCAL"},{"code":"877403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054953 = Hospital System Supply Identifier | 877403 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054950","type":"LOCAL"},{"code":"877400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054950 = Hospital System Supply Identifier | 877400 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054954","type":"LOCAL"},{"code":"877404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054954 = Hospital System Supply Identifier | 877404 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054955","type":"LOCAL"},{"code":"877405","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054955 = Hospital System Supply Identifier | 877405 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054956","type":"LOCAL"},{"code":"877406","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054956 = Hospital System Supply Identifier | 877406 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054957","type":"LOCAL"},{"code":"877407","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054957 = Hospital System Supply Identifier | 877407 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054958","type":"LOCAL"},{"code":"877408","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054958 = Hospital System Supply Identifier | 877408 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054960","type":"LOCAL"},{"code":"877410","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054960 = Hospital System Supply Identifier | 877410 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054959","type":"LOCAL"},{"code":"877409","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054959 = Hospital System Supply Identifier | 877409 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054961","type":"LOCAL"},{"code":"877411","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054961 = Hospital System Supply Identifier | 877411 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054962","type":"LOCAL"},{"code":"877412","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054962 = Hospital System Supply Identifier | 877412 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054963","type":"LOCAL"},{"code":"877413","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054963 = Hospital System Supply Identifier | 877413 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054964","type":"LOCAL"},{"code":"877414","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054964 = Hospital System Supply Identifier | 877414 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054965","type":"LOCAL"},{"code":"877415","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054965 = Hospital System Supply Identifier | 877415 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054970","type":"LOCAL"},{"code":"877420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054970 = Hospital System Supply Identifier | 877420 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054968","type":"LOCAL"},{"code":"877418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054968 = Hospital System Supply Identifier | 877418 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054969","type":"LOCAL"},{"code":"877419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054969 = Hospital System Supply Identifier | 877419 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054966","type":"LOCAL"},{"code":"877416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054966 = Hospital System Supply Identifier | 877416 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054967","type":"LOCAL"},{"code":"877417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054967 = Hospital System Supply Identifier | 877417 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054971","type":"LOCAL"},{"code":"877421","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054971 = Hospital System Supply Identifier | 877421 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054972","type":"LOCAL"},{"code":"877422","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054972 = Hospital System Supply Identifier | 877422 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054973","type":"LOCAL"},{"code":"877423","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054973 = Hospital System Supply Identifier | 877423 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054974","type":"LOCAL"},{"code":"877424","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054974 = Hospital System Supply Identifier | 877424 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054975","type":"LOCAL"},{"code":"877425","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054975 = Hospital System Supply Identifier | 877425 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054979","type":"LOCAL"},{"code":"877429","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054979 = Hospital System Supply Identifier | 877429 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054978","type":"LOCAL"},{"code":"877428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054978 = Hospital System Supply Identifier | 877428 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054980","type":"LOCAL"},{"code":"877430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054980 = Hospital System Supply Identifier | 877430 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054976","type":"LOCAL"},{"code":"877426","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054976 = Hospital System Supply Identifier | 877426 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054977","type":"LOCAL"},{"code":"877427","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054977 = Hospital System Supply Identifier | 877427 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054982","type":"LOCAL"},{"code":"877432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054982 = Hospital System Supply Identifier | 877432 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054981","type":"LOCAL"},{"code":"877431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054981 = Hospital System Supply Identifier | 877431 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054983","type":"LOCAL"},{"code":"877433","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054983 = Hospital System Supply Identifier | 877433 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054984","type":"LOCAL"},{"code":"877434","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054984 = Hospital System Supply Identifier | 877434 = Lawson ID"}]},{"description":"SCREW CANN P/T 4.5X80MM","code_information":[{"code":"Sx00-1400-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054985","type":"LOCAL"},{"code":"877435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054985 = Hospital System Supply Identifier | 877435 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054986","type":"LOCAL"},{"code":"877436","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054986 = Hospital System Supply Identifier | 877436 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054987","type":"LOCAL"},{"code":"877437","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054987 = Hospital System Supply Identifier | 877437 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054988","type":"LOCAL"},{"code":"877438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054988 = Hospital System Supply Identifier | 877438 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054989","type":"LOCAL"},{"code":"877439","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054989 = Hospital System Supply Identifier | 877439 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054990","type":"LOCAL"},{"code":"877440","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054990 = Hospital System Supply Identifier | 877440 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054995","type":"LOCAL"},{"code":"877445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054995 = Hospital System Supply Identifier | 877445 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054994","type":"LOCAL"},{"code":"877444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054994 = Hospital System Supply Identifier | 877444 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054993","type":"LOCAL"},{"code":"877443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054993 = Hospital System Supply Identifier | 877443 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054992","type":"LOCAL"},{"code":"877442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054992 = Hospital System Supply Identifier | 877442 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054991","type":"LOCAL"},{"code":"877441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054991 = Hospital System Supply Identifier | 877441 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054996","type":"LOCAL"},{"code":"877446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054996 = Hospital System Supply Identifier | 877446 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054997","type":"LOCAL"},{"code":"877447","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054997 = Hospital System Supply Identifier | 877447 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054998","type":"LOCAL"},{"code":"877448","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054998 = Hospital System Supply Identifier | 877448 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1054999","type":"LOCAL"},{"code":"877449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1054999 = Hospital System Supply Identifier | 877449 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055000","type":"LOCAL"},{"code":"877450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055000 = Hospital System Supply Identifier | 877450 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055001","type":"LOCAL"},{"code":"877451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055001 = Hospital System Supply Identifier | 877451 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055002","type":"LOCAL"},{"code":"877452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055002 = Hospital System Supply Identifier | 877452 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055004","type":"LOCAL"},{"code":"877454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055004 = Hospital System Supply Identifier | 877454 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055003","type":"LOCAL"},{"code":"877453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055003 = Hospital System Supply Identifier | 877453 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055005","type":"LOCAL"},{"code":"877455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055005 = Hospital System Supply Identifier | 877455 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055006","type":"LOCAL"},{"code":"877456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055006 = Hospital System Supply Identifier | 877456 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055007","type":"LOCAL"},{"code":"877457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055007 = Hospital System Supply Identifier | 877457 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055008","type":"LOCAL"},{"code":"877458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055008 = Hospital System Supply Identifier | 877458 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055009","type":"LOCAL"},{"code":"877459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055009 = Hospital System Supply Identifier | 877459 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055010","type":"LOCAL"},{"code":"877460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055010 = Hospital System Supply Identifier | 877460 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055011","type":"LOCAL"},{"code":"877461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055011 = Hospital System Supply Identifier | 877461 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055013","type":"LOCAL"},{"code":"877463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055013 = Hospital System Supply Identifier | 877463 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055014","type":"LOCAL"},{"code":"877464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055014 = Hospital System Supply Identifier | 877464 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055012","type":"LOCAL"},{"code":"877462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055012 = Hospital System Supply Identifier | 877462 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055015","type":"LOCAL"},{"code":"877465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055015 = Hospital System Supply Identifier | 877465 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055016","type":"LOCAL"},{"code":"877466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055016 = Hospital System Supply Identifier | 877466 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055017","type":"LOCAL"},{"code":"877467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055017 = Hospital System Supply Identifier | 877467 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055018","type":"LOCAL"},{"code":"877468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055018 = Hospital System Supply Identifier | 877468 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055019","type":"LOCAL"},{"code":"877469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055019 = Hospital System Supply Identifier | 877469 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055020","type":"LOCAL"},{"code":"877470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055020 = Hospital System Supply Identifier | 877470 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055022","type":"LOCAL"},{"code":"877472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055022 = Hospital System Supply Identifier | 877472 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055021","type":"LOCAL"},{"code":"877471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055021 = Hospital System Supply Identifier | 877471 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055024","type":"LOCAL"},{"code":"877474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055024 = Hospital System Supply Identifier | 877474 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055023","type":"LOCAL"},{"code":"877473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055023 = Hospital System Supply Identifier | 877473 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055025","type":"LOCAL"},{"code":"877475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055025 = Hospital System Supply Identifier | 877475 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055026","type":"LOCAL"},{"code":"877476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055026 = Hospital System Supply Identifier | 877476 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055027","type":"LOCAL"},{"code":"877477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055027 = Hospital System Supply Identifier | 877477 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055028","type":"LOCAL"},{"code":"877478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055028 = Hospital System Supply Identifier | 877478 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055029","type":"LOCAL"},{"code":"877479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055029 = Hospital System Supply Identifier | 877479 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055030","type":"LOCAL"},{"code":"877480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055030 = Hospital System Supply Identifier | 877480 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055035","type":"LOCAL"},{"code":"877485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055035 = Hospital System Supply Identifier | 877485 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055034","type":"LOCAL"},{"code":"877484","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055034 = Hospital System Supply Identifier | 877484 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055033","type":"LOCAL"},{"code":"877483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055033 = Hospital System Supply Identifier | 877483 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055032","type":"LOCAL"},{"code":"877482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055032 = Hospital System Supply Identifier | 877482 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055031","type":"LOCAL"},{"code":"877481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055031 = Hospital System Supply Identifier | 877481 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055036","type":"LOCAL"},{"code":"877486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055036 = Hospital System Supply Identifier | 877486 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055037","type":"LOCAL"},{"code":"877487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055037 = Hospital System Supply Identifier | 877487 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055038","type":"LOCAL"},{"code":"877488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055038 = Hospital System Supply Identifier | 877488 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055039","type":"LOCAL"},{"code":"877489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055039 = Hospital System Supply Identifier | 877489 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055040","type":"LOCAL"},{"code":"877490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055040 = Hospital System Supply Identifier | 877490 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055041","type":"LOCAL"},{"code":"877491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055041 = Hospital System Supply Identifier | 877491 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055042","type":"LOCAL"},{"code":"877492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055042 = Hospital System Supply Identifier | 877492 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055044","type":"LOCAL"},{"code":"877494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055044 = Hospital System Supply Identifier | 877494 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055043","type":"LOCAL"},{"code":"877493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055043 = Hospital System Supply Identifier | 877493 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055045","type":"LOCAL"},{"code":"877495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055045 = Hospital System Supply Identifier | 877495 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055046","type":"LOCAL"},{"code":"877496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055046 = Hospital System Supply Identifier | 877496 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055047","type":"LOCAL"},{"code":"877497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055047 = Hospital System Supply Identifier | 877497 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055048","type":"LOCAL"},{"code":"877498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055048 = Hospital System Supply Identifier | 877498 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055049","type":"LOCAL"},{"code":"877499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055049 = Hospital System Supply Identifier | 877499 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055050","type":"LOCAL"},{"code":"877500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055050 = Hospital System Supply Identifier | 877500 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055051","type":"LOCAL"},{"code":"877501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1559.25,"discounted_cash":545.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055051 = Hospital System Supply Identifier | 877501 = Lawson ID"}]},{"description":"SCREW-WASHER CANN 6.5/7.3MM","code_information":[{"code":"Sx00-1402-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055052","type":"LOCAL"},{"code":"877502","type":"LOCAL"}],"standard_charges":[{"gross_charge":227.25,"discounted_cash":79.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055052 = Hospital System Supply Identifier | 877502 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X35","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055054","type":"LOCAL"},{"code":"877504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055054 = Hospital System Supply Identifier | 877504 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X30","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055053","type":"LOCAL"},{"code":"877503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055053 = Hospital System Supply Identifier | 877503 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X40","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055055","type":"LOCAL"},{"code":"877505","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055055 = Hospital System Supply Identifier | 877505 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X45","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055056","type":"LOCAL"},{"code":"877506","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055056 = Hospital System Supply Identifier | 877506 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X50","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055057","type":"LOCAL"},{"code":"877507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055057 = Hospital System Supply Identifier | 877507 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X55","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055058","type":"LOCAL"},{"code":"877508","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055058 = Hospital System Supply Identifier | 877508 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X60","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055059","type":"LOCAL"},{"code":"877509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055059 = Hospital System Supply Identifier | 877509 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X65","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055060","type":"LOCAL"},{"code":"877510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055060 = Hospital System Supply Identifier | 877510 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X70","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055061","type":"LOCAL"},{"code":"877511","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055061 = Hospital System Supply Identifier | 877511 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X75","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055062","type":"LOCAL"},{"code":"877512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055062 = Hospital System Supply Identifier | 877512 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X80","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055063","type":"LOCAL"},{"code":"877513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055063 = Hospital System Supply Identifier | 877513 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X85","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055064","type":"LOCAL"},{"code":"877514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055064 = Hospital System Supply Identifier | 877514 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X95","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055066","type":"LOCAL"},{"code":"877516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055066 = Hospital System Supply Identifier | 877516 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X90","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055065","type":"LOCAL"},{"code":"877515","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055065 = Hospital System Supply Identifier | 877515 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X100","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055067","type":"LOCAL"},{"code":"877517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055067 = Hospital System Supply Identifier | 877517 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X105","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055068","type":"LOCAL"},{"code":"877518","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055068 = Hospital System Supply Identifier | 877518 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X110","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055069","type":"LOCAL"},{"code":"877519","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055069 = Hospital System Supply Identifier | 877519 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X115","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055070","type":"LOCAL"},{"code":"877520","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055070 = Hospital System Supply Identifier | 877520 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X120","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055071","type":"LOCAL"},{"code":"877521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055071 = Hospital System Supply Identifier | 877521 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X125","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055072","type":"LOCAL"},{"code":"877522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055072 = Hospital System Supply Identifier | 877522 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X130","code_information":[{"code":"Sx00-1402-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055073","type":"LOCAL"},{"code":"877523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055073 = Hospital System Supply Identifier | 877523 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X38","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055078","type":"LOCAL"},{"code":"877528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055078 = Hospital System Supply Identifier | 877528 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X36","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055077","type":"LOCAL"},{"code":"877527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055077 = Hospital System Supply Identifier | 877527 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X32","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055075","type":"LOCAL"},{"code":"877525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055075 = Hospital System Supply Identifier | 877525 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X30","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055074","type":"LOCAL"},{"code":"877524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055074 = Hospital System Supply Identifier | 877524 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X34","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055076","type":"LOCAL"},{"code":"877526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055076 = Hospital System Supply Identifier | 877526 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X40","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055079","type":"LOCAL"},{"code":"877529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055079 = Hospital System Supply Identifier | 877529 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X42","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055080","type":"LOCAL"},{"code":"877530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055080 = Hospital System Supply Identifier | 877530 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X44","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055081","type":"LOCAL"},{"code":"877531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055081 = Hospital System Supply Identifier | 877531 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X46","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055082","type":"LOCAL"},{"code":"877532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055082 = Hospital System Supply Identifier | 877532 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X48","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055083","type":"LOCAL"},{"code":"877533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055083 = Hospital System Supply Identifier | 877533 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X58","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055088","type":"LOCAL"},{"code":"877538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055088 = Hospital System Supply Identifier | 877538 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X54","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055086","type":"LOCAL"},{"code":"877536","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055086 = Hospital System Supply Identifier | 877536 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X56","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055087","type":"LOCAL"},{"code":"877537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055087 = Hospital System Supply Identifier | 877537 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X50","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055084","type":"LOCAL"},{"code":"877534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055084 = Hospital System Supply Identifier | 877534 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X52","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055085","type":"LOCAL"},{"code":"877535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055085 = Hospital System Supply Identifier | 877535 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X60","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055089","type":"LOCAL"},{"code":"877539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055089 = Hospital System Supply Identifier | 877539 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X62","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055090","type":"LOCAL"},{"code":"877540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055090 = Hospital System Supply Identifier | 877540 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X64","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055093","type":"LOCAL"},{"code":"877541","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055093 = Hospital System Supply Identifier | 877541 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X66","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055094","type":"LOCAL"},{"code":"877542","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055094 = Hospital System Supply Identifier | 877542 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X68","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055095","type":"LOCAL"},{"code":"877543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055095 = Hospital System Supply Identifier | 877543 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X76","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055099","type":"LOCAL"},{"code":"877547","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055099 = Hospital System Supply Identifier | 877547 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X78","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055100","type":"LOCAL"},{"code":"877548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055100 = Hospital System Supply Identifier | 877548 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X74","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055098","type":"LOCAL"},{"code":"877546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055098 = Hospital System Supply Identifier | 877546 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X72","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055097","type":"LOCAL"},{"code":"877545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055097 = Hospital System Supply Identifier | 877545 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X70","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055096","type":"LOCAL"},{"code":"877544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055096 = Hospital System Supply Identifier | 877544 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X80","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055101","type":"LOCAL"},{"code":"877549","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055101 = Hospital System Supply Identifier | 877549 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X82","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055102","type":"LOCAL"},{"code":"877550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055102 = Hospital System Supply Identifier | 877550 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X84","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055103","type":"LOCAL"},{"code":"877551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055103 = Hospital System Supply Identifier | 877551 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X86","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055104","type":"LOCAL"},{"code":"877552","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055104 = Hospital System Supply Identifier | 877552 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X88","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055105","type":"LOCAL"},{"code":"877553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055105 = Hospital System Supply Identifier | 877553 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X90","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055106","type":"LOCAL"},{"code":"877554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055106 = Hospital System Supply Identifier | 877554 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X95","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055107","type":"LOCAL"},{"code":"877555","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055107 = Hospital System Supply Identifier | 877555 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X105","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055109","type":"LOCAL"},{"code":"877557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055109 = Hospital System Supply Identifier | 877557 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X100","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055108","type":"LOCAL"},{"code":"877556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055108 = Hospital System Supply Identifier | 877556 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X115","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055111","type":"LOCAL"},{"code":"877559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055111 = Hospital System Supply Identifier | 877559 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X110","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055110","type":"LOCAL"},{"code":"877558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055110 = Hospital System Supply Identifier | 877558 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X120","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055112","type":"LOCAL"},{"code":"877560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055112 = Hospital System Supply Identifier | 877560 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X125","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055113","type":"LOCAL"},{"code":"877561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055113 = Hospital System Supply Identifier | 877561 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X130","code_information":[{"code":"Sx00-1402-213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055114","type":"LOCAL"},{"code":"877562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055114 = Hospital System Supply Identifier | 877562 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X30","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055115","type":"LOCAL"},{"code":"877563","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055115 = Hospital System Supply Identifier | 877563 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X35","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055116","type":"LOCAL"},{"code":"877564","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055116 = Hospital System Supply Identifier | 877564 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X40","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055117","type":"LOCAL"},{"code":"877565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055117 = Hospital System Supply Identifier | 877565 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X45","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055118","type":"LOCAL"},{"code":"877566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055118 = Hospital System Supply Identifier | 877566 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X50","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055119","type":"LOCAL"},{"code":"877567","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055119 = Hospital System Supply Identifier | 877567 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X55","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055120","type":"LOCAL"},{"code":"877568","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055120 = Hospital System Supply Identifier | 877568 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X65","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055122","type":"LOCAL"},{"code":"877570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055122 = Hospital System Supply Identifier | 877570 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X60","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055121","type":"LOCAL"},{"code":"877569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055121 = Hospital System Supply Identifier | 877569 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X70","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055123","type":"LOCAL"},{"code":"877571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055123 = Hospital System Supply Identifier | 877571 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X75","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055124","type":"LOCAL"},{"code":"877572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055124 = Hospital System Supply Identifier | 877572 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X80","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055125","type":"LOCAL"},{"code":"877573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055125 = Hospital System Supply Identifier | 877573 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X85","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055126","type":"LOCAL"},{"code":"877574","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055126 = Hospital System Supply Identifier | 877574 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X90","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055127","type":"LOCAL"},{"code":"877575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055127 = Hospital System Supply Identifier | 877575 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X95","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055128","type":"LOCAL"},{"code":"877576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055128 = Hospital System Supply Identifier | 877576 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X100","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055129","type":"LOCAL"},{"code":"877577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055129 = Hospital System Supply Identifier | 877577 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X105","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055130","type":"LOCAL"},{"code":"877578","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055130 = Hospital System Supply Identifier | 877578 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X115","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055132","type":"LOCAL"},{"code":"877580","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055132 = Hospital System Supply Identifier | 877580 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X110","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055131","type":"LOCAL"},{"code":"877579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055131 = Hospital System Supply Identifier | 877579 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X120","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055133","type":"LOCAL"},{"code":"877581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055133 = Hospital System Supply Identifier | 877581 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X125","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055134","type":"LOCAL"},{"code":"877582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055134 = Hospital System Supply Identifier | 877582 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X130","code_information":[{"code":"Sx00-1402-513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055135","type":"LOCAL"},{"code":"877583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055135 = Hospital System Supply Identifier | 877583 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X30","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055136","type":"LOCAL"},{"code":"877584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055136 = Hospital System Supply Identifier | 877584 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X32","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055137","type":"LOCAL"},{"code":"877585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055137 = Hospital System Supply Identifier | 877585 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X34","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055138","type":"LOCAL"},{"code":"877586","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055138 = Hospital System Supply Identifier | 877586 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X36","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055139","type":"LOCAL"},{"code":"877587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055139 = Hospital System Supply Identifier | 877587 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X38","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055140","type":"LOCAL"},{"code":"877588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055140 = Hospital System Supply Identifier | 877588 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X48","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055145","type":"LOCAL"},{"code":"877593","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055145 = Hospital System Supply Identifier | 877593 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X46","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055144","type":"LOCAL"},{"code":"877592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055144 = Hospital System Supply Identifier | 877592 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X40","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055141","type":"LOCAL"},{"code":"877589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055141 = Hospital System Supply Identifier | 877589 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X42","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055142","type":"LOCAL"},{"code":"877590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055142 = Hospital System Supply Identifier | 877590 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X44","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055143","type":"LOCAL"},{"code":"877591","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055143 = Hospital System Supply Identifier | 877591 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X56","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055149","type":"LOCAL"},{"code":"877597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055149 = Hospital System Supply Identifier | 877597 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X50","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055146","type":"LOCAL"},{"code":"877594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055146 = Hospital System Supply Identifier | 877594 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X52","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055147","type":"LOCAL"},{"code":"877595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055147 = Hospital System Supply Identifier | 877595 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X54","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055148","type":"LOCAL"},{"code":"877596","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055148 = Hospital System Supply Identifier | 877596 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X58","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055150","type":"LOCAL"},{"code":"877598","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055150 = Hospital System Supply Identifier | 877598 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X68","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055155","type":"LOCAL"},{"code":"877603","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055155 = Hospital System Supply Identifier | 877603 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X66","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055154","type":"LOCAL"},{"code":"877602","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055154 = Hospital System Supply Identifier | 877602 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X62","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055152","type":"LOCAL"},{"code":"877600","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055152 = Hospital System Supply Identifier | 877600 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X64","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055153","type":"LOCAL"},{"code":"877601","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055153 = Hospital System Supply Identifier | 877601 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X60","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055151","type":"LOCAL"},{"code":"877599","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055151 = Hospital System Supply Identifier | 877599 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X70","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055156","type":"LOCAL"},{"code":"877604","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055156 = Hospital System Supply Identifier | 877604 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X72","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055157","type":"LOCAL"},{"code":"877605","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055157 = Hospital System Supply Identifier | 877605 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X74","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055158","type":"LOCAL"},{"code":"877606","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055158 = Hospital System Supply Identifier | 877606 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X76","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055159","type":"LOCAL"},{"code":"877607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055159 = Hospital System Supply Identifier | 877607 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X78","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055160","type":"LOCAL"},{"code":"877608","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055160 = Hospital System Supply Identifier | 877608 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X88","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055165","type":"LOCAL"},{"code":"877613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055165 = Hospital System Supply Identifier | 877613 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X86","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055164","type":"LOCAL"},{"code":"877612","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055164 = Hospital System Supply Identifier | 877612 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X82","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055162","type":"LOCAL"},{"code":"877610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055162 = Hospital System Supply Identifier | 877610 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X80","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055161","type":"LOCAL"},{"code":"877609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055161 = Hospital System Supply Identifier | 877609 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X84","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055163","type":"LOCAL"},{"code":"877611","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055163 = Hospital System Supply Identifier | 877611 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X90","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055166","type":"LOCAL"},{"code":"877614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055166 = Hospital System Supply Identifier | 877614 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X95","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055167","type":"LOCAL"},{"code":"877615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055167 = Hospital System Supply Identifier | 877615 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X100","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055168","type":"LOCAL"},{"code":"877616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055168 = Hospital System Supply Identifier | 877616 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X105","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055169","type":"LOCAL"},{"code":"877617","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055169 = Hospital System Supply Identifier | 877617 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X110","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055170","type":"LOCAL"},{"code":"877618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055170 = Hospital System Supply Identifier | 877618 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X115","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055171","type":"LOCAL"},{"code":"877619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055171 = Hospital System Supply Identifier | 877619 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X125","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055173","type":"LOCAL"},{"code":"877621","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055173 = Hospital System Supply Identifier | 877621 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X120","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055172","type":"LOCAL"},{"code":"877620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055172 = Hospital System Supply Identifier | 877620 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X130","code_information":[{"code":"Sx00-1402-613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055174","type":"LOCAL"},{"code":"877622","type":"LOCAL"}],"standard_charges":[{"gross_charge":1707.75,"discounted_cash":597.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055174 = Hospital System Supply Identifier | 877622 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026345 SS 6.5X45MM","code_information":[{"code":"Sx00-1402-634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357242","type":"LOCAL"},{"code":"1082486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357242 = Hospital System Supply Identifier | 1082486 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026355 SS 6.5X55MM","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356332","type":"LOCAL"},{"code":"1082535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356332 = Hospital System Supply Identifier | 1082535 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356515","type":"LOCAL"},{"code":"1083660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356515 = Hospital System Supply Identifier | 1083660 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026365 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356734","type":"LOCAL"},{"code":"1082540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356734 = Hospital System Supply Identifier | 1082540 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356855","type":"LOCAL"},{"code":"1083704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356855 = Hospital System Supply Identifier | 1083704 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026375 SS 6.5X75MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356629","type":"LOCAL"},{"code":"1082532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356629 = Hospital System Supply Identifier | 1082532 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026370 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356840","type":"LOCAL"},{"code":"1082597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356840 = Hospital System Supply Identifier | 1082597 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026380 SS 6.5X80MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357051","type":"LOCAL"},{"code":"1082559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357051 = Hospital System Supply Identifier | 1082559 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026385 SS 6.5X85MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356911","type":"LOCAL"},{"code":"1082513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356911 = Hospital System Supply Identifier | 1082513 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026390 SS 6.5X90MM","code_information":[{"code":"Sx00-1402-639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356965","type":"LOCAL"},{"code":"1082507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356965 = Hospital System Supply Identifier | 1082507 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027065 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356731","type":"LOCAL"},{"code":"1082443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356731 = Hospital System Supply Identifier | 1082443 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027070 SS 7.3X70MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356427","type":"LOCAL"},{"code":"1082456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356427 = Hospital System Supply Identifier | 1082456 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027075 SS 7.3X75MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357033","type":"LOCAL"},{"code":"1082521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357033 = Hospital System Supply Identifier | 1082521 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027085 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356967","type":"LOCAL"},{"code":"1082545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356967 = Hospital System Supply Identifier | 1082545 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356499","type":"LOCAL"},{"code":"1083619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356499 = Hospital System Supply Identifier | 1083619 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027095 SS 7.3X95MM","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356612","type":"LOCAL"},{"code":"1082428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356612 = Hospital System Supply Identifier | 1082428 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356378","type":"LOCAL"},{"code":"1083550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356378 = Hospital System Supply Identifier | 1083550 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027100 SS 7.3X100MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356636","type":"LOCAL"},{"code":"1082474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356636 = Hospital System Supply Identifier | 1082474 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027105 SS 7.3X105MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356713","type":"LOCAL"},{"code":"1082581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356713 = Hospital System Supply Identifier | 1082581 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027115 SS 7.3X115MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356592","type":"LOCAL"},{"code":"1082543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356592 = Hospital System Supply Identifier | 1082543 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027110 SS 7.3X110MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356555","type":"LOCAL"},{"code":"1082449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356555 = Hospital System Supply Identifier | 1082449 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027120 SS 7.3X120MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356503","type":"LOCAL"},{"code":"1082432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356503 = Hospital System Supply Identifier | 1082432 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027125 SS 7.3X125MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356613","type":"LOCAL"},{"code":"1082445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356613 = Hospital System Supply Identifier | 1082445 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027130 SS 7.3X130MM","code_information":[{"code":"Sx00-1402-713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357080","type":"LOCAL"},{"code":"1082554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357080 = Hospital System Supply Identifier | 1082554 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027345 SS 7.3X45MM","code_information":[{"code":"Sx00-1402-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356707","type":"LOCAL"},{"code":"1082530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356707 = Hospital System Supply Identifier | 1082530 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027350 SS 7.3X50MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357078","type":"LOCAL"},{"code":"1082509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357078 = Hospital System Supply Identifier | 1082509 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027355 SS 7.3X55MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357111","type":"LOCAL"},{"code":"1082517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357111 = Hospital System Supply Identifier | 1082517 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027365 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356374","type":"LOCAL"},{"code":"1082476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356374 = Hospital System Supply Identifier | 1082476 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027360 SS 7.3X60MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356693","type":"LOCAL"},{"code":"1082595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356693 = Hospital System Supply Identifier | 1082595 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357224","type":"LOCAL"},{"code":"1083728","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357224 = Hospital System Supply Identifier | 1083728 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356846","type":"LOCAL"},{"code":"1083727","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356846 = Hospital System Supply Identifier | 1083727 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027385 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356606","type":"LOCAL"},{"code":"1082504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356606 = Hospital System Supply Identifier | 1082504 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356746","type":"LOCAL"},{"code":"1083554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356746 = Hospital System Supply Identifier | 1083554 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356621","type":"LOCAL"},{"code":"1083548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356621 = Hospital System Supply Identifier | 1083548 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028065 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356689","type":"LOCAL"},{"code":"1082566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356689 = Hospital System Supply Identifier | 1082566 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028070 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356571","type":"LOCAL"},{"code":"1082550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356571 = Hospital System Supply Identifier | 1082550 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356344","type":"LOCAL"},{"code":"1083712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356344 = Hospital System Supply Identifier | 1083712 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356519","type":"LOCAL"},{"code":"1083556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356519 = Hospital System Supply Identifier | 1083556 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356488","type":"LOCAL"},{"code":"1083658","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356488 = Hospital System Supply Identifier | 1083658 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028095 SS 6.5X95MM","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356834","type":"LOCAL"},{"code":"1082480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356834 = Hospital System Supply Identifier | 1082480 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356858","type":"LOCAL"},{"code":"1083535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356858 = Hospital System Supply Identifier | 1083535 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028100 SS 6.5X100MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356935","type":"LOCAL"},{"code":"1082560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356935 = Hospital System Supply Identifier | 1082560 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028105 SS 6.5X105MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356992","type":"LOCAL"},{"code":"1082485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356992 = Hospital System Supply Identifier | 1082485 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028110 SS 6.5X110MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356960","type":"LOCAL"},{"code":"1082441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356960 = Hospital System Supply Identifier | 1082441 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028115 SS 6.5X115MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356984","type":"LOCAL"},{"code":"1082460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356984 = Hospital System Supply Identifier | 1082460 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028125 SS 6.5X125MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356799","type":"LOCAL"},{"code":"1082430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356799 = Hospital System Supply Identifier | 1082430 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028120 SS 6.5X120MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357029","type":"LOCAL"},{"code":"1082431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357029 = Hospital System Supply Identifier | 1082431 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028130 SS 6.5X130MM","code_information":[{"code":"Sx00-1402-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356672","type":"LOCAL"},{"code":"1082457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1984.5,"discounted_cash":694.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356672 = Hospital System Supply Identifier | 1082457 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055179","type":"LOCAL"},{"code":"877627","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055179 = Hospital System Supply Identifier | 877627 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055177","type":"LOCAL"},{"code":"877625","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055177 = Hospital System Supply Identifier | 877625 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055178","type":"LOCAL"},{"code":"877626","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055178 = Hospital System Supply Identifier | 877626 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055175","type":"LOCAL"},{"code":"877623","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055175 = Hospital System Supply Identifier | 877623 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055176","type":"LOCAL"},{"code":"877624","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055176 = Hospital System Supply Identifier | 877624 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055180","type":"LOCAL"},{"code":"877628","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055180 = Hospital System Supply Identifier | 877628 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055181","type":"LOCAL"},{"code":"877629","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055181 = Hospital System Supply Identifier | 877629 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055182","type":"LOCAL"},{"code":"877630","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055182 = Hospital System Supply Identifier | 877630 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055183","type":"LOCAL"},{"code":"877631","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055183 = Hospital System Supply Identifier | 877631 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055184","type":"LOCAL"},{"code":"877632","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055184 = Hospital System Supply Identifier | 877632 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055186","type":"LOCAL"},{"code":"877634","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055186 = Hospital System Supply Identifier | 877634 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055185","type":"LOCAL"},{"code":"877633","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055185 = Hospital System Supply Identifier | 877633 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055187","type":"LOCAL"},{"code":"877635","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055187 = Hospital System Supply Identifier | 877635 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055192","type":"LOCAL"},{"code":"877640","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055192 = Hospital System Supply Identifier | 877640 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055191","type":"LOCAL"},{"code":"877639","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055191 = Hospital System Supply Identifier | 877639 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055190","type":"LOCAL"},{"code":"877638","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055190 = Hospital System Supply Identifier | 877638 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055189","type":"LOCAL"},{"code":"877637","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055189 = Hospital System Supply Identifier | 877637 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055188","type":"LOCAL"},{"code":"877636","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055188 = Hospital System Supply Identifier | 877636 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055193","type":"LOCAL"},{"code":"877641","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055193 = Hospital System Supply Identifier | 877641 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055194","type":"LOCAL"},{"code":"877642","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055194 = Hospital System Supply Identifier | 877642 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM LT","code_information":[{"code":"Sx00-1501-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055195","type":"LOCAL"},{"code":"877643","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055195 = Hospital System Supply Identifier | 877643 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055199","type":"LOCAL"},{"code":"877647","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055199 = Hospital System Supply Identifier | 877647 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055198","type":"LOCAL"},{"code":"877646","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055198 = Hospital System Supply Identifier | 877646 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055200","type":"LOCAL"},{"code":"877648","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055200 = Hospital System Supply Identifier | 877648 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055196","type":"LOCAL"},{"code":"877644","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055196 = Hospital System Supply Identifier | 877644 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055197","type":"LOCAL"},{"code":"877645","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055197 = Hospital System Supply Identifier | 877645 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055201","type":"LOCAL"},{"code":"877649","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055201 = Hospital System Supply Identifier | 877649 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055202","type":"LOCAL"},{"code":"877650","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055202 = Hospital System Supply Identifier | 877650 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 0MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055203","type":"LOCAL"},{"code":"877651","type":"LOCAL"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055203 = Hospital System Supply Identifier | 877651 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 5MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055204","type":"LOCAL"},{"code":"877652","type":"LOCAL"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055204 = Hospital System Supply Identifier | 877652 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 10MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055205","type":"LOCAL"},{"code":"877653","type":"LOCAL"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":218.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055205 = Hospital System Supply Identifier | 877653 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 15MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055206","type":"LOCAL"},{"code":"877654","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055206 = Hospital System Supply Identifier | 877654 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 20MM","code_information":[{"code":"Sx00-1501-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055207","type":"LOCAL"},{"code":"877655","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055207 = Hospital System Supply Identifier | 877655 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356557","type":"LOCAL"},{"code":"1083709","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356557 = Hospital System Supply Identifier | 1083709 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356506","type":"LOCAL"},{"code":"1083649","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356506 = Hospital System Supply Identifier | 1083649 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357184","type":"LOCAL"},{"code":"1083705","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357184 = Hospital System Supply Identifier | 1083705 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357038","type":"LOCAL"},{"code":"1083692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357038 = Hospital System Supply Identifier | 1083692 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356875","type":"LOCAL"},{"code":"1083573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356875 = Hospital System Supply Identifier | 1083573 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055208","type":"LOCAL"},{"code":"877656","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055208 = Hospital System Supply Identifier | 877656 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055209","type":"LOCAL"},{"code":"877657","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055209 = Hospital System Supply Identifier | 877657 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055210","type":"LOCAL"},{"code":"877658","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055210 = Hospital System Supply Identifier | 877658 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055211","type":"LOCAL"},{"code":"877659","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055211 = Hospital System Supply Identifier | 877659 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055212","type":"LOCAL"},{"code":"877660","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055212 = Hospital System Supply Identifier | 877660 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055217","type":"LOCAL"},{"code":"877665","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055217 = Hospital System Supply Identifier | 877665 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055215","type":"LOCAL"},{"code":"877663","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055215 = Hospital System Supply Identifier | 877663 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055216","type":"LOCAL"},{"code":"877664","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055216 = Hospital System Supply Identifier | 877664 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055213","type":"LOCAL"},{"code":"877661","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055213 = Hospital System Supply Identifier | 877661 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055214","type":"LOCAL"},{"code":"877662","type":"LOCAL"}],"standard_charges":[{"gross_charge":17724.0,"discounted_cash":6203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055214 = Hospital System Supply Identifier | 877662 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055218","type":"LOCAL"},{"code":"877666","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055218 = Hospital System Supply Identifier | 877666 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055219","type":"LOCAL"},{"code":"877667","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055219 = Hospital System Supply Identifier | 877667 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055220","type":"LOCAL"},{"code":"877668","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055220 = Hospital System Supply Identifier | 877668 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055224","type":"LOCAL"},{"code":"877672","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055224 = Hospital System Supply Identifier | 877672 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055221","type":"LOCAL"},{"code":"877669","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055221 = Hospital System Supply Identifier | 877669 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055222","type":"LOCAL"},{"code":"877670","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055222 = Hospital System Supply Identifier | 877670 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055223","type":"LOCAL"},{"code":"877671","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055223 = Hospital System Supply Identifier | 877671 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055225","type":"LOCAL"},{"code":"877673","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055225 = Hospital System Supply Identifier | 877673 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055227","type":"LOCAL"},{"code":"877675","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055227 = Hospital System Supply Identifier | 877675 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055226","type":"LOCAL"},{"code":"877674","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055226 = Hospital System Supply Identifier | 877674 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM RT","code_information":[{"code":"Sx00-1502-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055228","type":"LOCAL"},{"code":"877676","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055228 = Hospital System Supply Identifier | 877676 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055229","type":"LOCAL"},{"code":"877677","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055229 = Hospital System Supply Identifier | 877677 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055230","type":"LOCAL"},{"code":"877678","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055230 = Hospital System Supply Identifier | 877678 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055231","type":"LOCAL"},{"code":"877679","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055231 = Hospital System Supply Identifier | 877679 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055232","type":"LOCAL"},{"code":"877680","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055232 = Hospital System Supply Identifier | 877680 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055233","type":"LOCAL"},{"code":"877681","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055233 = Hospital System Supply Identifier | 877681 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055234","type":"LOCAL"},{"code":"877682","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055234 = Hospital System Supply Identifier | 877682 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055235","type":"LOCAL"},{"code":"877683","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055235 = Hospital System Supply Identifier | 877683 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM LT","code_information":[{"code":"Sx00-1503-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055236","type":"LOCAL"},{"code":"877684","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055236 = Hospital System Supply Identifier | 877684 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055241","type":"LOCAL"},{"code":"877689","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055241 = Hospital System Supply Identifier | 877689 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055240","type":"LOCAL"},{"code":"877688","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055240 = Hospital System Supply Identifier | 877688 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055237","type":"LOCAL"},{"code":"877685","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055237 = Hospital System Supply Identifier | 877685 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055238","type":"LOCAL"},{"code":"877686","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055238 = Hospital System Supply Identifier | 877686 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055239","type":"LOCAL"},{"code":"877687","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055239 = Hospital System Supply Identifier | 877687 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357264","type":"LOCAL"},{"code":"1083571","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357264 = Hospital System Supply Identifier | 1083571 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356973","type":"LOCAL"},{"code":"1083596","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356973 = Hospital System Supply Identifier | 1083596 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357236","type":"LOCAL"},{"code":"1083657","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357236 = Hospital System Supply Identifier | 1083657 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055242","type":"LOCAL"},{"code":"877690","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055242 = Hospital System Supply Identifier | 877690 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055243","type":"LOCAL"},{"code":"877691","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055243 = Hospital System Supply Identifier | 877691 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055247","type":"LOCAL"},{"code":"877695","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055247 = Hospital System Supply Identifier | 877695 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055248","type":"LOCAL"},{"code":"877696","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055248 = Hospital System Supply Identifier | 877696 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055245","type":"LOCAL"},{"code":"877693","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055245 = Hospital System Supply Identifier | 877693 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055244","type":"LOCAL"},{"code":"877692","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055244 = Hospital System Supply Identifier | 877692 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055246","type":"LOCAL"},{"code":"877694","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055246 = Hospital System Supply Identifier | 877694 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357221","type":"LOCAL"},{"code":"1083647","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357221 = Hospital System Supply Identifier | 1083647 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356354","type":"LOCAL"},{"code":"1083680","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356354 = Hospital System Supply Identifier | 1083680 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356802","type":"LOCAL"},{"code":"1083713","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356802 = Hospital System Supply Identifier | 1083713 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055249","type":"LOCAL"},{"code":"877697","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055249 = Hospital System Supply Identifier | 877697 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055250","type":"LOCAL"},{"code":"877698","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055250 = Hospital System Supply Identifier | 877698 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055255","type":"LOCAL"},{"code":"877703","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055255 = Hospital System Supply Identifier | 877703 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055254","type":"LOCAL"},{"code":"877702","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055254 = Hospital System Supply Identifier | 877702 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055252","type":"LOCAL"},{"code":"877700","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055252 = Hospital System Supply Identifier | 877700 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055251","type":"LOCAL"},{"code":"877699","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055251 = Hospital System Supply Identifier | 877699 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055253","type":"LOCAL"},{"code":"877701","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055253 = Hospital System Supply Identifier | 877701 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055256","type":"LOCAL"},{"code":"877704","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055256 = Hospital System Supply Identifier | 877704 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356623","type":"LOCAL"},{"code":"1083577","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356623 = Hospital System Supply Identifier | 1083577 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356725","type":"LOCAL"},{"code":"1083611","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356725 = Hospital System Supply Identifier | 1083611 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356500","type":"LOCAL"},{"code":"1083662","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356500 = Hospital System Supply Identifier | 1083662 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055257","type":"LOCAL"},{"code":"877705","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055257 = Hospital System Supply Identifier | 877705 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055261","type":"LOCAL"},{"code":"877709","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055261 = Hospital System Supply Identifier | 877709 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055262","type":"LOCAL"},{"code":"877710","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055262 = Hospital System Supply Identifier | 877710 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055260","type":"LOCAL"},{"code":"877708","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055260 = Hospital System Supply Identifier | 877708 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055259","type":"LOCAL"},{"code":"877707","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055259 = Hospital System Supply Identifier | 877707 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055258","type":"LOCAL"},{"code":"877706","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055258 = Hospital System Supply Identifier | 877706 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356764","type":"LOCAL"},{"code":"1083552","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356764 = Hospital System Supply Identifier | 1083552 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356697","type":"LOCAL"},{"code":"1083726","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356697 = Hospital System Supply Identifier | 1083726 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357204","type":"LOCAL"},{"code":"1083751","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357204 = Hospital System Supply Identifier | 1083751 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055263","type":"LOCAL"},{"code":"877711","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055263 = Hospital System Supply Identifier | 877711 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055264","type":"LOCAL"},{"code":"877712","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055264 = Hospital System Supply Identifier | 877712 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 0MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055265","type":"LOCAL"},{"code":"877713","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055265 = Hospital System Supply Identifier | 877713 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 5MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055266","type":"LOCAL"},{"code":"877714","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055266 = Hospital System Supply Identifier | 877714 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 15MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055268","type":"LOCAL"},{"code":"877716","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055268 = Hospital System Supply Identifier | 877716 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 10MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055267","type":"LOCAL"},{"code":"877715","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055267 = Hospital System Supply Identifier | 877715 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 20MM","code_information":[{"code":"Sx00-1503-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055269","type":"LOCAL"},{"code":"877717","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":288.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055269 = Hospital System Supply Identifier | 877717 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356718","type":"LOCAL"},{"code":"1083654","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356718 = Hospital System Supply Identifier | 1083654 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356353","type":"LOCAL"},{"code":"1083667","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356353 = Hospital System Supply Identifier | 1083667 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356972","type":"LOCAL"},{"code":"1083561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356972 = Hospital System Supply Identifier | 1083561 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357122","type":"LOCAL"},{"code":"1083609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357122 = Hospital System Supply Identifier | 1083609 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356626","type":"LOCAL"},{"code":"1083677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.75,"discounted_cash":459.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356626 = Hospital System Supply Identifier | 1083677 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM RT","code_information":[{"code":"Sx00-1504-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055270","type":"LOCAL"},{"code":"877718","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055270 = Hospital System Supply Identifier | 877718 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055275","type":"LOCAL"},{"code":"877723","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055275 = Hospital System Supply Identifier | 877723 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055274","type":"LOCAL"},{"code":"877722","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055274 = Hospital System Supply Identifier | 877722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055273","type":"LOCAL"},{"code":"877721","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055273 = Hospital System Supply Identifier | 877721 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055272","type":"LOCAL"},{"code":"877720","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055272 = Hospital System Supply Identifier | 877720 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055271","type":"LOCAL"},{"code":"877719","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055271 = Hospital System Supply Identifier | 877719 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356513","type":"LOCAL"},{"code":"1083557","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356513 = Hospital System Supply Identifier | 1083557 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356518","type":"LOCAL"},{"code":"1083574","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356518 = Hospital System Supply Identifier | 1083574 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356339","type":"LOCAL"},{"code":"1083734","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356339 = Hospital System Supply Identifier | 1083734 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055276","type":"LOCAL"},{"code":"877724","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055276 = Hospital System Supply Identifier | 877724 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055277","type":"LOCAL"},{"code":"877725","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055277 = Hospital System Supply Identifier | 877725 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055282","type":"LOCAL"},{"code":"877730","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055282 = Hospital System Supply Identifier | 877730 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055281","type":"LOCAL"},{"code":"877729","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055281 = Hospital System Supply Identifier | 877729 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055280","type":"LOCAL"},{"code":"877728","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055280 = Hospital System Supply Identifier | 877728 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055279","type":"LOCAL"},{"code":"877727","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055279 = Hospital System Supply Identifier | 877727 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055278","type":"LOCAL"},{"code":"877726","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055278 = Hospital System Supply Identifier | 877726 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356379","type":"LOCAL"},{"code":"1083555","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356379 = Hospital System Supply Identifier | 1083555 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356950","type":"LOCAL"},{"code":"1083653","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356950 = Hospital System Supply Identifier | 1083653 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356719","type":"LOCAL"},{"code":"1083666","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356719 = Hospital System Supply Identifier | 1083666 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055283","type":"LOCAL"},{"code":"877731","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055283 = Hospital System Supply Identifier | 877731 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055284","type":"LOCAL"},{"code":"877732","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055284 = Hospital System Supply Identifier | 877732 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055288","type":"LOCAL"},{"code":"877736","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055288 = Hospital System Supply Identifier | 877736 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055287","type":"LOCAL"},{"code":"877735","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055287 = Hospital System Supply Identifier | 877735 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055289","type":"LOCAL"},{"code":"877737","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055289 = Hospital System Supply Identifier | 877737 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055285","type":"LOCAL"},{"code":"877733","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055285 = Hospital System Supply Identifier | 877733 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055286","type":"LOCAL"},{"code":"877734","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055286 = Hospital System Supply Identifier | 877734 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356747","type":"LOCAL"},{"code":"1083543","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356747 = Hospital System Supply Identifier | 1083543 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356971","type":"LOCAL"},{"code":"1083602","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356971 = Hospital System Supply Identifier | 1083602 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356939","type":"LOCAL"},{"code":"1083722","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356939 = Hospital System Supply Identifier | 1083722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055290","type":"LOCAL"},{"code":"877738","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055290 = Hospital System Supply Identifier | 877738 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055291","type":"LOCAL"},{"code":"877739","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055291 = Hospital System Supply Identifier | 877739 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055296","type":"LOCAL"},{"code":"877744","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055296 = Hospital System Supply Identifier | 877744 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055295","type":"LOCAL"},{"code":"877743","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055295 = Hospital System Supply Identifier | 877743 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055292","type":"LOCAL"},{"code":"877740","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055292 = Hospital System Supply Identifier | 877740 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055293","type":"LOCAL"},{"code":"877741","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055293 = Hospital System Supply Identifier | 877741 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055294","type":"LOCAL"},{"code":"877742","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055294 = Hospital System Supply Identifier | 877742 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357120","type":"LOCAL"},{"code":"1083570","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357120 = Hospital System Supply Identifier | 1083570 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356729","type":"LOCAL"},{"code":"1083679","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356729 = Hospital System Supply Identifier | 1083679 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357084","type":"LOCAL"},{"code":"1083750","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357084 = Hospital System Supply Identifier | 1083750 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055297","type":"LOCAL"},{"code":"877745","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055297 = Hospital System Supply Identifier | 877745 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055298","type":"LOCAL"},{"code":"877746","type":"LOCAL"}],"standard_charges":[{"gross_charge":16575.0,"discounted_cash":5801.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055298 = Hospital System Supply Identifier | 877746 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X27.5MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055300","type":"LOCAL"},{"code":"877748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055300 = Hospital System Supply Identifier | 877748 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X25MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055299","type":"LOCAL"},{"code":"877747","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055299 = Hospital System Supply Identifier | 877747 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X37.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055304","type":"LOCAL"},{"code":"877752","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055304 = Hospital System Supply Identifier | 877752 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X35MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055303","type":"LOCAL"},{"code":"877751","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055303 = Hospital System Supply Identifier | 877751 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X30MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055301","type":"LOCAL"},{"code":"877749","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055301 = Hospital System Supply Identifier | 877749 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X32.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055302","type":"LOCAL"},{"code":"877750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055302 = Hospital System Supply Identifier | 877750 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X40MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055305","type":"LOCAL"},{"code":"877753","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055305 = Hospital System Supply Identifier | 877753 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X42.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055306","type":"LOCAL"},{"code":"877754","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055306 = Hospital System Supply Identifier | 877754 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X45MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055307","type":"LOCAL"},{"code":"877755","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055307 = Hospital System Supply Identifier | 877755 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X47.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055308","type":"LOCAL"},{"code":"877756","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055308 = Hospital System Supply Identifier | 877756 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X50MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055309","type":"LOCAL"},{"code":"877757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055309 = Hospital System Supply Identifier | 877757 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X52.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055310","type":"LOCAL"},{"code":"877758","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055310 = Hospital System Supply Identifier | 877758 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X55MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055311","type":"LOCAL"},{"code":"877759","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055311 = Hospital System Supply Identifier | 877759 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X57.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055312","type":"LOCAL"},{"code":"877760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055312 = Hospital System Supply Identifier | 877760 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X60MM","code_information":[{"code":"Sx00-1506-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055313","type":"LOCAL"},{"code":"877761","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055313 = Hospital System Supply Identifier | 877761 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356390","type":"LOCAL"},{"code":"1083583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356390 = Hospital System Supply Identifier | 1083583 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356748","type":"LOCAL"},{"code":"1083546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356748 = Hospital System Supply Identifier | 1083546 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356497","type":"LOCAL"},{"code":"1083562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356497 = Hospital System Supply Identifier | 1083562 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356940","type":"LOCAL"},{"code":"1083737","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356940 = Hospital System Supply Identifier | 1083737 = Lawson ID"}]},{"description":"SCREW F/T 4.5X25MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055314","type":"LOCAL"},{"code":"877762","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055314 = Hospital System Supply Identifier | 877762 = Lawson ID"}]},{"description":"SCREW F/T 4.5X27.5MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055315","type":"LOCAL"},{"code":"877763","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055315 = Hospital System Supply Identifier | 877763 = Lawson ID"}]},{"description":"SCREW F/T 4.5X30MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055316","type":"LOCAL"},{"code":"877764","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055316 = Hospital System Supply Identifier | 877764 = Lawson ID"}]},{"description":"SCREW F/T 4.5X32.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055317","type":"LOCAL"},{"code":"877765","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055317 = Hospital System Supply Identifier | 877765 = Lawson ID"}]},{"description":"SCREW F/T 4.5X35MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055318","type":"LOCAL"},{"code":"877766","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055318 = Hospital System Supply Identifier | 877766 = Lawson ID"}]},{"description":"SCREW F/T 4.5X37.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055319","type":"LOCAL"},{"code":"877767","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055319 = Hospital System Supply Identifier | 877767 = Lawson ID"}]},{"description":"SCREW F/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055323","type":"LOCAL"},{"code":"877771","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055323 = Hospital System Supply Identifier | 877771 = Lawson ID"}]},{"description":"SCREW F/T 4.5X45MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055322","type":"LOCAL"},{"code":"877770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055322 = Hospital System Supply Identifier | 877770 = Lawson ID"}]},{"description":"SCREW F/T 4.5X40MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055320","type":"LOCAL"},{"code":"877768","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055320 = Hospital System Supply Identifier | 877768 = Lawson ID"}]},{"description":"SCREW F/T 4.5X42.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055321","type":"LOCAL"},{"code":"877769","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055321 = Hospital System Supply Identifier | 877769 = Lawson ID"}]},{"description":"SCREW F/T 4.5X50MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055324","type":"LOCAL"},{"code":"877772","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055324 = Hospital System Supply Identifier | 877772 = Lawson ID"}]},{"description":"SCREW F/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055325","type":"LOCAL"},{"code":"877773","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055325 = Hospital System Supply Identifier | 877773 = Lawson ID"}]},{"description":"SCREW F/T 4.5X55MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055326","type":"LOCAL"},{"code":"877774","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055326 = Hospital System Supply Identifier | 877774 = Lawson ID"}]},{"description":"SCREW F/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055327","type":"LOCAL"},{"code":"877775","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055327 = Hospital System Supply Identifier | 877775 = Lawson ID"}]},{"description":"SCREW F/T 4.5X60MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055328","type":"LOCAL"},{"code":"877776","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055328 = Hospital System Supply Identifier | 877776 = Lawson ID"}]},{"description":"SCREW F/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055329","type":"LOCAL"},{"code":"877777","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055329 = Hospital System Supply Identifier | 877777 = Lawson ID"}]},{"description":"SCREW F/T 4.5X65MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055330","type":"LOCAL"},{"code":"877778","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055330 = Hospital System Supply Identifier | 877778 = Lawson ID"}]},{"description":"SCREW F/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055331","type":"LOCAL"},{"code":"877779","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055331 = Hospital System Supply Identifier | 877779 = Lawson ID"}]},{"description":"SCREW F/T 4.5X75MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055333","type":"LOCAL"},{"code":"877781","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055333 = Hospital System Supply Identifier | 877781 = Lawson ID"}]},{"description":"SCREW F/T 4.5X70MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055332","type":"LOCAL"},{"code":"877780","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055332 = Hospital System Supply Identifier | 877780 = Lawson ID"}]},{"description":"SCREW F/T 4.5X80MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055334","type":"LOCAL"},{"code":"877782","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055334 = Hospital System Supply Identifier | 877782 = Lawson ID"}]},{"description":"SCREW F/T 4.5X85MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055335","type":"LOCAL"},{"code":"877783","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055335 = Hospital System Supply Identifier | 877783 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356504","type":"LOCAL"},{"code":"1083581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356504 = Hospital System Supply Identifier | 1083581 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357094","type":"LOCAL"},{"code":"1083696","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357094 = Hospital System Supply Identifier | 1083696 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356988","type":"LOCAL"},{"code":"1083582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356988 = Hospital System Supply Identifier | 1083582 = Lawson ID"}]},{"description":"SCREW P/T 4.5X45MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055336","type":"LOCAL"},{"code":"877784","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055336 = Hospital System Supply Identifier | 877784 = Lawson ID"}]},{"description":"SCREW P/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055337","type":"LOCAL"},{"code":"877785","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055337 = Hospital System Supply Identifier | 877785 = Lawson ID"}]},{"description":"SCREW P/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055341","type":"LOCAL"},{"code":"877789","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055341 = Hospital System Supply Identifier | 877789 = Lawson ID"}]},{"description":"SCREW P/T 4.5X55MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055340","type":"LOCAL"},{"code":"877788","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055340 = Hospital System Supply Identifier | 877788 = Lawson ID"}]},{"description":"SCREW P/T 4.5X50MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055338","type":"LOCAL"},{"code":"877786","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055338 = Hospital System Supply Identifier | 877786 = Lawson ID"}]},{"description":"SCREW P/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055339","type":"LOCAL"},{"code":"877787","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055339 = Hospital System Supply Identifier | 877787 = Lawson ID"}]},{"description":"SCREW P/T 4.5X60MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055342","type":"LOCAL"},{"code":"877790","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055342 = Hospital System Supply Identifier | 877790 = Lawson ID"}]},{"description":"SCREW P/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055343","type":"LOCAL"},{"code":"877791","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055343 = Hospital System Supply Identifier | 877791 = Lawson ID"}]},{"description":"SCREW P/T 4.5X65MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055344","type":"LOCAL"},{"code":"877792","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055344 = Hospital System Supply Identifier | 877792 = Lawson ID"}]},{"description":"SCREW P/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055345","type":"LOCAL"},{"code":"877793","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055345 = Hospital System Supply Identifier | 877793 = Lawson ID"}]},{"description":"SCREW P/T 4.5X70MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055346","type":"LOCAL"},{"code":"877794","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055346 = Hospital System Supply Identifier | 877794 = Lawson ID"}]},{"description":"SCREW P/T 4.5X75MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055347","type":"LOCAL"},{"code":"877795","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055347 = Hospital System Supply Identifier | 877795 = Lawson ID"}]},{"description":"SCREW P/T 4.5X80MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055348","type":"LOCAL"},{"code":"877796","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055348 = Hospital System Supply Identifier | 877796 = Lawson ID"}]},{"description":"SCREW P/T 4.5X85MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055349","type":"LOCAL"},{"code":"877797","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055349 = Hospital System Supply Identifier | 877797 = Lawson ID"}]},{"description":"SCREW P/T 4.5X90MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055350","type":"LOCAL"},{"code":"877798","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055350 = Hospital System Supply Identifier | 877798 = Lawson ID"}]},{"description":"SCREW P/T 4.5X95MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055351","type":"LOCAL"},{"code":"877799","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055351 = Hospital System Supply Identifier | 877799 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357228","type":"LOCAL"},{"code":"1083731","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357228 = Hospital System Supply Identifier | 1083731 = Lawson ID"}]},{"description":"SCREW P/T 4.5X100MM","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055352","type":"LOCAL"},{"code":"877800","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055352 = Hospital System Supply Identifier | 877800 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356485","type":"LOCAL"},{"code":"1083715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356485 = Hospital System Supply Identifier | 1083715 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356758","type":"LOCAL"},{"code":"1083595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356758 = Hospital System Supply Identifier | 1083595 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356987","type":"LOCAL"},{"code":"1083540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1509.75,"discounted_cash":528.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356987 = Hospital System Supply Identifier | 1083540 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357217","type":"LOCAL"},{"code":"1083711","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357217 = Hospital System Supply Identifier | 1083711 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356974","type":"LOCAL"},{"code":"1083610","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356974 = Hospital System Supply Identifier | 1083610 = Lawson ID"}]},{"description":"SCREW F/T 5.0X27.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055354","type":"LOCAL"},{"code":"877802","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055354 = Hospital System Supply Identifier | 877802 = Lawson ID"}]},{"description":"SCREW F/T 5.0X25MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055353","type":"LOCAL"},{"code":"877801","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055353 = Hospital System Supply Identifier | 877801 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED FEMORAL PNP FEMUR 0015064023 5.0X22.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356495","type":"LOCAL"},{"code":"1082572","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356495 = Hospital System Supply Identifier | 1082572 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356720","type":"LOCAL"},{"code":"1083718","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356720 = Hospital System Supply Identifier | 1083718 = Lawson ID"}]},{"description":"SCREW F/T 5.0X30MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055355","type":"LOCAL"},{"code":"877803","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055355 = Hospital System Supply Identifier | 877803 = Lawson ID"}]},{"description":"SCREW F/T 5.0X32.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055356","type":"LOCAL"},{"code":"877804","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055356 = Hospital System Supply Identifier | 877804 = Lawson ID"}]},{"description":"SCREW F/T 5.0X35MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055357","type":"LOCAL"},{"code":"877805","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055357 = Hospital System Supply Identifier | 877805 = Lawson ID"}]},{"description":"SCREW F/T 5.0X37.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055358","type":"LOCAL"},{"code":"877806","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055358 = Hospital System Supply Identifier | 877806 = Lawson ID"}]},{"description":"SCREW F/T 5.0X45MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055361","type":"LOCAL"},{"code":"877809","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055361 = Hospital System Supply Identifier | 877809 = Lawson ID"}]},{"description":"SCREW F/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055362","type":"LOCAL"},{"code":"877810","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055362 = Hospital System Supply Identifier | 877810 = Lawson ID"}]},{"description":"SCREW F/T 5.0X40MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055359","type":"LOCAL"},{"code":"877807","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055359 = Hospital System Supply Identifier | 877807 = Lawson ID"}]},{"description":"SCREW F/T 5.0X42.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055360","type":"LOCAL"},{"code":"877808","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055360 = Hospital System Supply Identifier | 877808 = Lawson ID"}]},{"description":"SCREW F/T 5.0X50MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055363","type":"LOCAL"},{"code":"877811","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055363 = Hospital System Supply Identifier | 877811 = Lawson ID"}]},{"description":"SCREW F/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055364","type":"LOCAL"},{"code":"877812","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055364 = Hospital System Supply Identifier | 877812 = Lawson ID"}]},{"description":"SCREW F/T 5.0X55MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055365","type":"LOCAL"},{"code":"877813","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055365 = Hospital System Supply Identifier | 877813 = Lawson ID"}]},{"description":"SCREW F/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055366","type":"LOCAL"},{"code":"877814","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055366 = Hospital System Supply Identifier | 877814 = Lawson ID"}]},{"description":"SCREW F/T 5.0X60MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055367","type":"LOCAL"},{"code":"877815","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055367 = Hospital System Supply Identifier | 877815 = Lawson ID"}]},{"description":"SCREW F/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055368","type":"LOCAL"},{"code":"877816","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055368 = Hospital System Supply Identifier | 877816 = Lawson ID"}]},{"description":"SCREW F/T 5.0X65MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055369","type":"LOCAL"},{"code":"877817","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055369 = Hospital System Supply Identifier | 877817 = Lawson ID"}]},{"description":"SCREW F/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055370","type":"LOCAL"},{"code":"877818","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055370 = Hospital System Supply Identifier | 877818 = Lawson ID"}]},{"description":"SCREW F/T 5.0X75MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055372","type":"LOCAL"},{"code":"877820","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055372 = Hospital System Supply Identifier | 877820 = Lawson ID"}]},{"description":"SCREW F/T 5.0X70MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055371","type":"LOCAL"},{"code":"877819","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055371 = Hospital System Supply Identifier | 877819 = Lawson ID"}]},{"description":"SCREW F/T 5.0X80MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055373","type":"LOCAL"},{"code":"877821","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055373 = Hospital System Supply Identifier | 877821 = Lawson ID"}]},{"description":"SCREW F/T 5.0X85MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055374","type":"LOCAL"},{"code":"877822","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055374 = Hospital System Supply Identifier | 877822 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357127","type":"LOCAL"},{"code":"1083584","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357127 = Hospital System Supply Identifier | 1083584 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356478","type":"LOCAL"},{"code":"1083738","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356478 = Hospital System Supply Identifier | 1083738 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356579","type":"LOCAL"},{"code":"1083720","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356579 = Hospital System Supply Identifier | 1083720 = Lawson ID"}]},{"description":"SCREW P/T 5.0X45MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055375","type":"LOCAL"},{"code":"877823","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055375 = Hospital System Supply Identifier | 877823 = Lawson ID"}]},{"description":"SCREW P/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055376","type":"LOCAL"},{"code":"877824","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055376 = Hospital System Supply Identifier | 877824 = Lawson ID"}]},{"description":"SCREW P/T 5.0X50MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055377","type":"LOCAL"},{"code":"877825","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055377 = Hospital System Supply Identifier | 877825 = Lawson ID"}]},{"description":"SCREW P/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055378","type":"LOCAL"},{"code":"877826","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055378 = Hospital System Supply Identifier | 877826 = Lawson ID"}]},{"description":"SCREW P/T 5.0X55MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055379","type":"LOCAL"},{"code":"877827","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055379 = Hospital System Supply Identifier | 877827 = Lawson ID"}]},{"description":"SCREW P/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055380","type":"LOCAL"},{"code":"877828","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055380 = Hospital System Supply Identifier | 877828 = Lawson ID"}]},{"description":"SCREW P/T 5.0X60MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055381","type":"LOCAL"},{"code":"877829","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055381 = Hospital System Supply Identifier | 877829 = Lawson ID"}]},{"description":"SCREW P/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055382","type":"LOCAL"},{"code":"877830","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055382 = Hospital System Supply Identifier | 877830 = Lawson ID"}]},{"description":"SCREW P/T 5.0X65MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055383","type":"LOCAL"},{"code":"877831","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055383 = Hospital System Supply Identifier | 877831 = Lawson ID"}]},{"description":"SCREW P/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055384","type":"LOCAL"},{"code":"877832","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055384 = Hospital System Supply Identifier | 877832 = Lawson ID"}]},{"description":"SCREW P/T 5.0X70MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055385","type":"LOCAL"},{"code":"877833","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055385 = Hospital System Supply Identifier | 877833 = Lawson ID"}]},{"description":"SCREW P/T 5.0X75MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055386","type":"LOCAL"},{"code":"877834","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055386 = Hospital System Supply Identifier | 877834 = Lawson ID"}]},{"description":"SCREW P/T 5.0X80MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055387","type":"LOCAL"},{"code":"877835","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055387 = Hospital System Supply Identifier | 877835 = Lawson ID"}]},{"description":"SCREW P/T 5.0X85MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055388","type":"LOCAL"},{"code":"877836","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055388 = Hospital System Supply Identifier | 877836 = Lawson ID"}]},{"description":"SCREW P/T 5.0X90MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055389","type":"LOCAL"},{"code":"877837","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055389 = Hospital System Supply Identifier | 877837 = Lawson ID"}]},{"description":"SCREW P/T 5.0X95MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055390","type":"LOCAL"},{"code":"877838","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055390 = Hospital System Supply Identifier | 877838 = Lawson ID"}]},{"description":"SCREW P/T 5.0X100MM","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1055391","type":"LOCAL"},{"code":"877839","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1055391 = Hospital System Supply Identifier | 877839 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356756","type":"LOCAL"},{"code":"1083665","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356756 = Hospital System Supply Identifier | 1083665 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356851","type":"LOCAL"},{"code":"1083622","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356851 = Hospital System Supply Identifier | 1083622 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357072","type":"LOCAL"},{"code":"1083725","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357072 = Hospital System Supply Identifier | 1083725 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356388","type":"LOCAL"},{"code":"1083687","type":"LOCAL"}],"standard_charges":[{"gross_charge":2327.5,"discounted_cash":814.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356388 = Hospital System Supply Identifier | 1083687 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356362","type":"LOCAL"},{"code":"1083633","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356362 = Hospital System Supply Identifier | 1083633 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356365","type":"LOCAL"},{"code":"1083695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356365 = Hospital System Supply Identifier | 1083695 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356860","type":"LOCAL"},{"code":"1083671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356860 = Hospital System Supply Identifier | 1083671 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357237","type":"LOCAL"},{"code":"1083681","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357237 = Hospital System Supply Identifier | 1083681 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356750","type":"LOCAL"},{"code":"1083626","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356750 = Hospital System Supply Identifier | 1083626 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356842","type":"LOCAL"},{"code":"1083632","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356842 = Hospital System Supply Identifier | 1083632 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357257","type":"LOCAL"},{"code":"1083551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357257 = Hospital System Supply Identifier | 1083551 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356991","type":"LOCAL"},{"code":"1083590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356991 = Hospital System Supply Identifier | 1083590 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356843","type":"LOCAL"},{"code":"1083698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356843 = Hospital System Supply Identifier | 1083698 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356600","type":"LOCAL"},{"code":"1083703","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356600 = Hospital System Supply Identifier | 1083703 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356757","type":"LOCAL"},{"code":"1083672","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356757 = Hospital System Supply Identifier | 1083672 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357119","type":"LOCAL"},{"code":"1083568","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357119 = Hospital System Supply Identifier | 1083568 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356381","type":"LOCAL"},{"code":"1083605","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356381 = Hospital System Supply Identifier | 1083605 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356760","type":"LOCAL"},{"code":"1083614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356760 = Hospital System Supply Identifier | 1083614 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356836","type":"LOCAL"},{"code":"1083697","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356836 = Hospital System Supply Identifier | 1083697 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356975","type":"LOCAL"},{"code":"1083623","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356975 = Hospital System Supply Identifier | 1083623 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356752","type":"LOCAL"},{"code":"1083542","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356752 = Hospital System Supply Identifier | 1083542 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357123","type":"LOCAL"},{"code":"1083618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357123 = Hospital System Supply Identifier | 1083618 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356717","type":"LOCAL"},{"code":"1083651","type":"LOCAL"}],"standard_charges":[{"gross_charge":1361.25,"discounted_cash":476.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356717 = Hospital System Supply Identifier | 1083651 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107240 TITANIUM 7X240MM","code_information":[{"code":"Sx00-1510-724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356373","type":"LOCAL"},{"code":"1082473","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356373 = Hospital System Supply Identifier | 1082473 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107255 TITANIUM 7X255MM","code_information":[{"code":"Sx00-1510-725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356867","type":"LOCAL"},{"code":"1082526","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356867 = Hospital System Supply Identifier | 1082526 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107270 TITANIUM 7X270MM","code_information":[{"code":"Sx00-1510-727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357210","type":"LOCAL"},{"code":"1082546","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357210 = Hospital System Supply Identifier | 1082546 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107285 TITANIUM 7X285MM","code_information":[{"code":"Sx00-1510-728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356728","type":"LOCAL"},{"code":"1082429","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356728 = Hospital System Supply Identifier | 1082429 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107300 TITANIUM 7X300MM","code_information":[{"code":"Sx00-1510-730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356706","type":"LOCAL"},{"code":"1082511","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356706 = Hospital System Supply Identifier | 1082511 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107315 TITANIUM 7X315MM","code_information":[{"code":"Sx00-1510-731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356742","type":"LOCAL"},{"code":"1082580","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356742 = Hospital System Supply Identifier | 1082580 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107330 TITANIUM 7X330MM","code_information":[{"code":"Sx00-1510-733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357052","type":"LOCAL"},{"code":"1082569","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357052 = Hospital System Supply Identifier | 1082569 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107345 TITANIUM 7X345MM","code_information":[{"code":"Sx00-1510-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356554","type":"LOCAL"},{"code":"1082439","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356554 = Hospital System Supply Identifier | 1082439 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107360 TITANIUM 7X360MM","code_information":[{"code":"Sx00-1510-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356614","type":"LOCAL"},{"code":"1082475","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356614 = Hospital System Supply Identifier | 1082475 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107375 TITANIUM 7X375MM","code_information":[{"code":"Sx00-1510-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357250","type":"LOCAL"},{"code":"1082549","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357250 = Hospital System Supply Identifier | 1082549 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107390 TITANIUM 7X390MM","code_information":[{"code":"Sx00-1510-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356831","type":"LOCAL"},{"code":"1082568","type":"LOCAL"}],"standard_charges":[{"gross_charge":17633.98,"discounted_cash":6171.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356831 = Hospital System Supply Identifier | 1082568 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108240 TITANIUM 8X240MM","code_information":[{"code":"Sx00-1510-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356494","type":"LOCAL"},{"code":"1082451","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356494 = Hospital System Supply Identifier | 1082451 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108255 TITANIUM 8X255MM","code_information":[{"code":"Sx00-1510-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357220","type":"LOCAL"},{"code":"1082593","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357220 = Hospital System Supply Identifier | 1082593 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108270 TITANIUM 8X270MM","code_information":[{"code":"Sx00-1510-827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356368","type":"LOCAL"},{"code":"1082490","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356368 = Hospital System Supply Identifier | 1082490 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108285 TITANIUM 8X285MM","code_information":[{"code":"Sx00-1510-828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356512","type":"LOCAL"},{"code":"1082436","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356512 = Hospital System Supply Identifier | 1082436 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108300 TITANIUM 8X300MM","code_information":[{"code":"Sx00-1510-830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356825","type":"LOCAL"},{"code":"1082563","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356825 = Hospital System Supply Identifier | 1082563 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108315 TITANIUM 8X315MM","code_information":[{"code":"Sx00-1510-831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356859","type":"LOCAL"},{"code":"1082427","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356859 = Hospital System Supply Identifier | 1082427 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108330 TITANIUM 8X330MM","code_information":[{"code":"Sx00-1510-833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357075","type":"LOCAL"},{"code":"1082591","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357075 = Hospital System Supply Identifier | 1082591 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108345 TITANIUM 8X345MM","code_information":[{"code":"Sx00-1510-834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356604","type":"LOCAL"},{"code":"1082437","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356604 = Hospital System Supply Identifier | 1082437 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108360 TITANIUM 8X360MM","code_information":[{"code":"Sx00-1510-836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357195","type":"LOCAL"},{"code":"1082542","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357195 = Hospital System Supply Identifier | 1082542 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108375 TITANIUM 8X375MM","code_information":[{"code":"Sx00-1510-837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356692","type":"LOCAL"},{"code":"1082586","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356692 = Hospital System Supply Identifier | 1082586 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108390 TITANIUM 8X390MM","code_information":[{"code":"Sx00-1510-839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357034","type":"LOCAL"},{"code":"1082525","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357034 = Hospital System Supply Identifier | 1082525 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108405 TITANIUM 8X405MM","code_information":[{"code":"Sx00-1510-840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356739","type":"LOCAL"},{"code":"1082470","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356739 = Hospital System Supply Identifier | 1082470 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108420 TITANIUM 8X420MM","code_information":[{"code":"Sx00-1510-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356475","type":"LOCAL"},{"code":"1082518","type":"LOCAL"}],"standard_charges":[{"gross_charge":18034.76,"discounted_cash":6312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356475 = Hospital System Supply Identifier | 1082518 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109240 TITANIUM 9X240MM","code_information":[{"code":"Sx00-1510-924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356910","type":"LOCAL"},{"code":"1082484","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356910 = Hospital System Supply Identifier | 1082484 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109255 TITANIUM 9X255MM","code_information":[{"code":"Sx00-1510-925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356511","type":"LOCAL"},{"code":"1082499","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356511 = Hospital System Supply Identifier | 1082499 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109270 TITANIUM 9X270MM","code_information":[{"code":"Sx00-1510-927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356727","type":"LOCAL"},{"code":"1082433","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356727 = Hospital System Supply Identifier | 1082433 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109285 TITANIUM 9X285MM","code_information":[{"code":"Sx00-1510-928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356705","type":"LOCAL"},{"code":"1082500","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356705 = Hospital System Supply Identifier | 1082500 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109300 TITANIUM 9X300MM","code_information":[{"code":"Sx00-1510-930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356389","type":"LOCAL"},{"code":"1082541","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356389 = Hospital System Supply Identifier | 1082541 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109315 TITANIUM 9X315MM","code_information":[{"code":"Sx00-1510-931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356830","type":"LOCAL"},{"code":"1082522","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356830 = Hospital System Supply Identifier | 1082522 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109330 TITANIUM 9X330MM","code_information":[{"code":"Sx00-1510-933","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357134","type":"LOCAL"},{"code":"1082537","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357134 = Hospital System Supply Identifier | 1082537 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109345 TITANIUM 9X345MM","code_information":[{"code":"Sx00-1510-934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356490","type":"LOCAL"},{"code":"1082506","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356490 = Hospital System Supply Identifier | 1082506 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109360 TITANIUM 9X360MM","code_information":[{"code":"Sx00-1510-936","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356476","type":"LOCAL"},{"code":"1082551","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356476 = Hospital System Supply Identifier | 1082551 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109375 TITANIUM 9X375MM","code_information":[{"code":"Sx00-1510-937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356845","type":"LOCAL"},{"code":"1082527","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356845 = Hospital System Supply Identifier | 1082527 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109390 TITANIUM 9X390MM","code_information":[{"code":"Sx00-1510-939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356491","type":"LOCAL"},{"code":"1082466","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356491 = Hospital System Supply Identifier | 1082466 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109405 TITANIUM 9X405MM","code_information":[{"code":"Sx00-1510-940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356735","type":"LOCAL"},{"code":"1082493","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356735 = Hospital System Supply Identifier | 1082493 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109420 TITANIUM 9X420MM","code_information":[{"code":"Sx00-1510-942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356489","type":"LOCAL"},{"code":"1082447","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356489 = Hospital System Supply Identifier | 1082447 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110270 TITANIUM 10X270MM","code_information":[{"code":"Sx00-1511-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357174","type":"LOCAL"},{"code":"1082440","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357174 = Hospital System Supply Identifier | 1082440 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110285 TITANIUM 10X285MM","code_information":[{"code":"Sx00-1511-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356768","type":"LOCAL"},{"code":"1082479","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356768 = Hospital System Supply Identifier | 1082479 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110300 TITANIUM 10X300MM","code_information":[{"code":"Sx00-1511-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356978","type":"LOCAL"},{"code":"1082552","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356978 = Hospital System Supply Identifier | 1082552 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110315 TITANIUM 10X315MM","code_information":[{"code":"Sx00-1511-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357110","type":"LOCAL"},{"code":"1082471","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357110 = Hospital System Supply Identifier | 1082471 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110330 TITANIUM 10X330MM","code_information":[{"code":"Sx00-1511-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356616","type":"LOCAL"},{"code":"1082458","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356616 = Hospital System Supply Identifier | 1082458 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110345 TITANIUM 10X345MM","code_information":[{"code":"Sx00-1511-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356357","type":"LOCAL"},{"code":"1082516","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356357 = Hospital System Supply Identifier | 1082516 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110360 TITANIUM 10X360MM","code_information":[{"code":"Sx00-1511-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357177","type":"LOCAL"},{"code":"1082528","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357177 = Hospital System Supply Identifier | 1082528 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110375 TITANIUM 10X375MM","code_information":[{"code":"Sx00-1511-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356320","type":"LOCAL"},{"code":"1082469","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356320 = Hospital System Supply Identifier | 1082469 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110390 TITANIUM 10X390MM","code_information":[{"code":"Sx00-1511-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357227","type":"LOCAL"},{"code":"1082598","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357227 = Hospital System Supply Identifier | 1082598 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110405 TITANIUM 10X405MM","code_information":[{"code":"Sx00-1511-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356673","type":"LOCAL"},{"code":"1082524","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356673 = Hospital System Supply Identifier | 1082524 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110420 TITANIUM 10X420MM","code_information":[{"code":"Sx00-1511-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356959","type":"LOCAL"},{"code":"1082489","type":"LOCAL"}],"standard_charges":[{"gross_charge":18454.14,"discounted_cash":6458.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356959 = Hospital System Supply Identifier | 1082489 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111270 TITANIUM 11X270MM","code_information":[{"code":"Sx00-1511-127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356800","type":"LOCAL"},{"code":"1082446","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356800 = Hospital System Supply Identifier | 1082446 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111285 TITANIUM 11X285MM","code_information":[{"code":"Sx00-1511-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357032","type":"LOCAL"},{"code":"1082498","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357032 = Hospital System Supply Identifier | 1082498 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111300 TITANIUM 11X300MM","code_information":[{"code":"Sx00-1511-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356583","type":"LOCAL"},{"code":"1082503","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356583 = Hospital System Supply Identifier | 1082503 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111315 TITANIUM 11X315MM","code_information":[{"code":"Sx00-1511-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356941","type":"LOCAL"},{"code":"1082501","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356941 = Hospital System Supply Identifier | 1082501 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111330 TITANIUM 11X330MM","code_information":[{"code":"Sx00-1511-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357249","type":"LOCAL"},{"code":"1082538","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357249 = Hospital System Supply Identifier | 1082538 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111345 TITANIUM 11X345MM","code_information":[{"code":"Sx00-1511-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356429","type":"LOCAL"},{"code":"1082508","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356429 = Hospital System Supply Identifier | 1082508 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111360 TITANIUM 11X360MM","code_information":[{"code":"Sx00-1511-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357096","type":"LOCAL"},{"code":"1082515","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357096 = Hospital System Supply Identifier | 1082515 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111375 TITANIUM 11X375MM","code_information":[{"code":"Sx00-1511-137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357138","type":"LOCAL"},{"code":"1082557","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357138 = Hospital System Supply Identifier | 1082557 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111390 TITANIUM 11X390MM","code_information":[{"code":"Sx00-1511-139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356605","type":"LOCAL"},{"code":"1082488","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356605 = Hospital System Supply Identifier | 1082488 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111405 TITANIUM 11X405MM","code_information":[{"code":"Sx00-1511-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356732","type":"LOCAL"},{"code":"1082472","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356732 = Hospital System Supply Identifier | 1082472 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111420 TITANIUM 11X420MM","code_information":[{"code":"Sx00-1511-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356346","type":"LOCAL"},{"code":"1082544","type":"LOCAL"}],"standard_charges":[{"gross_charge":18893.53,"discounted_cash":6612.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356346 = Hospital System Supply Identifier | 1082544 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112285 TITANIUM 12X285MM","code_information":[{"code":"Sx00-1511-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356319","type":"LOCAL"},{"code":"1082462","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356319 = Hospital System Supply Identifier | 1082462 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112300 TITANIUM 12X300MM","code_information":[{"code":"Sx00-1511-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357256","type":"LOCAL"},{"code":"1082567","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357256 = Hospital System Supply Identifier | 1082567 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112315 TITANIUM 12X315MM","code_information":[{"code":"Sx00-1511-231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357178","type":"LOCAL"},{"code":"1082520","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357178 = Hospital System Supply Identifier | 1082520 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112330 TITANIUM 12X330MM","code_information":[{"code":"Sx00-1511-233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356738","type":"LOCAL"},{"code":"1082452","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356738 = Hospital System Supply Identifier | 1082452 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112345 TITANIUM 12X345MM","code_information":[{"code":"Sx00-1511-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356671","type":"LOCAL"},{"code":"1082434","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356671 = Hospital System Supply Identifier | 1082434 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112360 TITANIUM 12X360MM","code_information":[{"code":"Sx00-1511-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357079","type":"LOCAL"},{"code":"1082533","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357079 = Hospital System Supply Identifier | 1082533 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112375 TITANIUM 12X375MM","code_information":[{"code":"Sx00-1511-237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356556","type":"LOCAL"},{"code":"1082512","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356556 = Hospital System Supply Identifier | 1082512 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112390 TITANIUM 12X390MM","code_information":[{"code":"Sx00-1511-239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356814","type":"LOCAL"},{"code":"1082596","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356814 = Hospital System Supply Identifier | 1082596 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112405 TITANIUM 12X405MM","code_information":[{"code":"Sx00-1511-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356801","type":"LOCAL"},{"code":"1082459","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356801 = Hospital System Supply Identifier | 1082459 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112420 TITANIUM 12X420MM","code_information":[{"code":"Sx00-1511-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356595","type":"LOCAL"},{"code":"1082564","type":"LOCAL"}],"standard_charges":[{"gross_charge":19354.35,"discounted_cash":6774.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356595 = Hospital System Supply Identifier | 1082564 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240025 4.0X25MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356866","type":"LOCAL"},{"code":"1082467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356866 = Hospital System Supply Identifier | 1082467 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240020 4.0X20MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357240","type":"LOCAL"},{"code":"1082497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357240 = Hospital System Supply Identifier | 1082497 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240030 4.0X30MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356922","type":"LOCAL"},{"code":"1082558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356922 = Hospital System Supply Identifier | 1082558 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240035 4.0X35MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356321","type":"LOCAL"},{"code":"1082519","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356321 = Hospital System Supply Identifier | 1082519 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240040 4.0X40MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357106","type":"LOCAL"},{"code":"1082455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357106 = Hospital System Supply Identifier | 1082455 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240045 4.0X45MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357214","type":"LOCAL"},{"code":"1082565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357214 = Hospital System Supply Identifier | 1082565 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240055 4.0X55MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356833","type":"LOCAL"},{"code":"1082444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356833 = Hospital System Supply Identifier | 1082444 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240050 4.0X50MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357054","type":"LOCAL"},{"code":"1082583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357054 = Hospital System Supply Identifier | 1082583 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240060 4.0X60MM","code_information":[{"code":"Sx00-1524-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356688","type":"LOCAL"},{"code":"1082539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356688 = Hospital System Supply Identifier | 1082539 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240175 4.0X17.5MM","code_information":[{"code":"Sx00-1524-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357176","type":"LOCAL"},{"code":"1082514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357176 = Hospital System Supply Identifier | 1082514 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240225 4.0X22.5MM","code_information":[{"code":"Sx00-1524-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356994","type":"LOCAL"},{"code":"1082578","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356994 = Hospital System Supply Identifier | 1082578 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240275 4.0X27.5MM","code_information":[{"code":"Sx00-1524-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356710","type":"LOCAL"},{"code":"1082465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356710 = Hospital System Supply Identifier | 1082465 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240325 4.0X32.5MM","code_information":[{"code":"Sx00-1524-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357248","type":"LOCAL"},{"code":"1082494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357248 = Hospital System Supply Identifier | 1082494 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240375 4.0X37.5MM","code_information":[{"code":"Sx00-1524-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356924","type":"LOCAL"},{"code":"1082573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356924 = Hospital System Supply Identifier | 1082573 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240425 4.0X42.5MM","code_information":[{"code":"Sx00-1524-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356943","type":"LOCAL"},{"code":"1082529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356943 = Hospital System Supply Identifier | 1082529 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240475 4.0X47.5MM","code_information":[{"code":"Sx00-1524-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357175","type":"LOCAL"},{"code":"1082442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357175 = Hospital System Supply Identifier | 1082442 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240525 4.0X52.5MM","code_information":[{"code":"Sx00-1524-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356803","type":"LOCAL"},{"code":"1082478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356803 = Hospital System Supply Identifier | 1082478 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240575 4.0X57.5MM","code_information":[{"code":"Sx00-1524-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357030","type":"LOCAL"},{"code":"1082477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1587.31,"discounted_cash":555.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357030 = Hospital System Supply Identifier | 1082477 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245020 4.5X20MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356733","type":"LOCAL"},{"code":"1082495","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356733 = Hospital System Supply Identifier | 1082495 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245025 4.5X25MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356572","type":"LOCAL"},{"code":"1082561","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356572 = Hospital System Supply Identifier | 1082561 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245035 4.5X35MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357089","type":"LOCAL"},{"code":"1082531","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357089 = Hospital System Supply Identifier | 1082531 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245030 4.5X30MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357055","type":"LOCAL"},{"code":"1082590","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357055 = Hospital System Supply Identifier | 1082590 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245045 4.5X45MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356465","type":"LOCAL"},{"code":"1082523","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356465 = Hospital System Supply Identifier | 1082523 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245040 4.5X40MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357031","type":"LOCAL"},{"code":"1082481","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357031 = Hospital System Supply Identifier | 1082481 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245050 4.5X50MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357261","type":"LOCAL"},{"code":"1082468","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357261 = Hospital System Supply Identifier | 1082468 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245055 4.5X55MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357082","type":"LOCAL"},{"code":"1082582","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357082 = Hospital System Supply Identifier | 1082582 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245065 4.5X65MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356586","type":"LOCAL"},{"code":"1082553","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356586 = Hospital System Supply Identifier | 1082553 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245060 4.5X60MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356832","type":"LOCAL"},{"code":"1082585","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356832 = Hospital System Supply Identifier | 1082585 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245070 4.5X70MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356371","type":"LOCAL"},{"code":"1082461","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356371 = Hospital System Supply Identifier | 1082461 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245075 4.5X75MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356573","type":"LOCAL"},{"code":"1082587","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356573 = Hospital System Supply Identifier | 1082587 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245080 4.5X80MM","code_information":[{"code":"Sx00-1524-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357137","type":"LOCAL"},{"code":"1082482","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357137 = Hospital System Supply Identifier | 1082482 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245175 4.5X17.5MM","code_information":[{"code":"Sx00-1524-517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357053","type":"LOCAL"},{"code":"1082576","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357053 = Hospital System Supply Identifier | 1082576 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245225 4.5X22.5MM","code_information":[{"code":"Sx00-1524-522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356372","type":"LOCAL"},{"code":"1082487","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356372 = Hospital System Supply Identifier | 1082487 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245275 4.5X27.5MM","code_information":[{"code":"Sx00-1524-527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356426","type":"LOCAL"},{"code":"1082453","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356426 = Hospital System Supply Identifier | 1082453 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245325 4.5X32.5MM","code_information":[{"code":"Sx00-1524-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356383","type":"LOCAL"},{"code":"1082575","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356383 = Hospital System Supply Identifier | 1082575 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245375 4.5X37.5MM","code_information":[{"code":"Sx00-1524-537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356690","type":"LOCAL"},{"code":"1082570","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356690 = Hospital System Supply Identifier | 1082570 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245425 4.5X42.5MM","code_information":[{"code":"Sx00-1524-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356691","type":"LOCAL"},{"code":"1082577","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356691 = Hospital System Supply Identifier | 1082577 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245475 4.5X47.5MM","code_information":[{"code":"Sx00-1524-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357244","type":"LOCAL"},{"code":"1082450","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357244 = Hospital System Supply Identifier | 1082450 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245525 4.5X52.5MM","code_information":[{"code":"Sx00-1524-552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356865","type":"LOCAL"},{"code":"1082510","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356865 = Hospital System Supply Identifier | 1082510 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245575 4.5X57.5MM","code_information":[{"code":"Sx00-1524-557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356945","type":"LOCAL"},{"code":"1082592","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356945 = Hospital System Supply Identifier | 1082592 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245625 4.5X62.5MM","code_information":[{"code":"Sx00-1524-562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356829","type":"LOCAL"},{"code":"1082502","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356829 = Hospital System Supply Identifier | 1082502 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245675 4.5X67.5MM","code_information":[{"code":"Sx00-1524-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357125","type":"LOCAL"},{"code":"1082594","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357125 = Hospital System Supply Identifier | 1082594 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245725 4.5X72.5MM","code_information":[{"code":"Sx00-1524-572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357081","type":"LOCAL"},{"code":"1082562","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357081 = Hospital System Supply Identifier | 1082562 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245775 4.5X77.5MM","code_information":[{"code":"Sx00-1524-577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357196","type":"LOCAL"},{"code":"1082589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2027.08,"discounted_cash":709.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357196 = Hospital System Supply Identifier | 1082589 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250025 5.0X25MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356349","type":"LOCAL"},{"code":"1082463","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356349 = Hospital System Supply Identifier | 1082463 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250020 5.0X20MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357270","type":"LOCAL"},{"code":"1082454","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357270 = Hospital System Supply Identifier | 1082454 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250030 5.0X30MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356961","type":"LOCAL"},{"code":"1082492","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356961 = Hospital System Supply Identifier | 1082492 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250035 5.0X35MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356585","type":"LOCAL"},{"code":"1082548","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356585 = Hospital System Supply Identifier | 1082548 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250045 5.0X45MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357107","type":"LOCAL"},{"code":"1082491","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357107 = Hospital System Supply Identifier | 1082491 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250040 5.0X40MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356347","type":"LOCAL"},{"code":"1082584","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356347 = Hospital System Supply Identifier | 1082584 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250055 5.0X55MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356958","type":"LOCAL"},{"code":"1082438","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356958 = Hospital System Supply Identifier | 1082438 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250050 5.0X50MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357215","type":"LOCAL"},{"code":"1082579","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357215 = Hospital System Supply Identifier | 1082579 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250060 5.0X60MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356864","type":"LOCAL"},{"code":"1082435","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356864 = Hospital System Supply Identifier | 1082435 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250065 5.0X65MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356923","type":"LOCAL"},{"code":"1082588","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356923 = Hospital System Supply Identifier | 1082588 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250070 5.0X70MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356424","type":"LOCAL"},{"code":"1082818","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356424 = Hospital System Supply Identifier | 1082818 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250075 5.0X75MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356902","type":"LOCAL"},{"code":"1082758","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356902 = Hospital System Supply Identifier | 1082758 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250080 5.0X80MM","code_information":[{"code":"Sx00-1525-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356443","type":"LOCAL"},{"code":"1082669","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356443 = Hospital System Supply Identifier | 1082669 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250175 5.0X17.5MM","code_information":[{"code":"Sx00-1525-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357170","type":"LOCAL"},{"code":"1082730","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357170 = Hospital System Supply Identifier | 1082730 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250225 5.0X22.5MM","code_information":[{"code":"Sx00-1525-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356380","type":"LOCAL"},{"code":"1082805","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356380 = Hospital System Supply Identifier | 1082805 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250275 5.0X27.5MM","code_information":[{"code":"Sx00-1525-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356783","type":"LOCAL"},{"code":"1082831","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356783 = Hospital System Supply Identifier | 1082831 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250325 5.0X32.5MM","code_information":[{"code":"Sx00-1525-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356314","type":"LOCAL"},{"code":"1082854","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356314 = Hospital System Supply Identifier | 1082854 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250375 5.0X37.5MM","code_information":[{"code":"Sx00-1525-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357207","type":"LOCAL"},{"code":"1082635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357207 = Hospital System Supply Identifier | 1082635 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250425 5.0X42.5MM","code_information":[{"code":"Sx00-1525-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356575","type":"LOCAL"},{"code":"1082632","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356575 = Hospital System Supply Identifier | 1082632 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250475 5.0X47.5MM","code_information":[{"code":"Sx00-1525-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356920","type":"LOCAL"},{"code":"1082620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356920 = Hospital System Supply Identifier | 1082620 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250525 5.0X52.5MM","code_information":[{"code":"Sx00-1525-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357201","type":"LOCAL"},{"code":"1082697","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357201 = Hospital System Supply Identifier | 1082697 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250575 5.0X57.5MM","code_information":[{"code":"Sx00-1525-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356669","type":"LOCAL"},{"code":"1082728","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356669 = Hospital System Supply Identifier | 1082728 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250625 5.0X62.5MM","code_information":[{"code":"Sx00-1525-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357064","type":"LOCAL"},{"code":"1082651","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357064 = Hospital System Supply Identifier | 1082651 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250675 5.0X67.5MM","code_information":[{"code":"Sx00-1525-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357226","type":"LOCAL"},{"code":"1082832","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357226 = Hospital System Supply Identifier | 1082832 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250725 5.0X72.5MM","code_information":[{"code":"Sx00-1525-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356818","type":"LOCAL"},{"code":"1082699","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356818 = Hospital System Supply Identifier | 1082699 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250775 5.0X77.5MM","code_information":[{"code":"Sx00-1525-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357044","type":"LOCAL"},{"code":"1082653","type":"LOCAL"}],"standard_charges":[{"gross_charge":2332.4,"discounted_cash":816.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357044 = Hospital System Supply Identifier | 1082653 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL FLUSH PNP TIBIA 0015300000","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356550","type":"LOCAL"},{"code":"1082637","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356550 = Hospital System Supply Identifier | 1082637 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300005 9.75X5MM","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356306","type":"LOCAL"},{"code":"1082721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356306 = Hospital System Supply Identifier | 1082721 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300015 9.75X15MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356442","type":"LOCAL"},{"code":"1082627","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356442 = Hospital System Supply Identifier | 1082627 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300010 9.75X10MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357208","type":"LOCAL"},{"code":"1082808","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357208 = Hospital System Supply Identifier | 1082808 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301005 10.5X5MM","code_information":[{"code":"Sx00-1530-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356893","type":"LOCAL"},{"code":"1082816","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356893 = Hospital System Supply Identifier | 1082816 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301010 10.5X10MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356652","type":"LOCAL"},{"code":"1082701","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356652 = Hospital System Supply Identifier | 1082701 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301015 10.5X15MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356529","type":"LOCAL"},{"code":"1082710","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356529 = Hospital System Supply Identifier | 1082710 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301105 11X5MM","code_information":[{"code":"Sx00-1530-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356782","type":"LOCAL"},{"code":"1082822","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356782 = Hospital System Supply Identifier | 1082822 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301115 11X15MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356653","type":"LOCAL"},{"code":"1082706","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356653 = Hospital System Supply Identifier | 1082706 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301110 11X10MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356956","type":"LOCAL"},{"code":"1082843","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356956 = Hospital System Supply Identifier | 1082843 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301205 12X5MM","code_information":[{"code":"Sx00-1530-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357114","type":"LOCAL"},{"code":"1082631","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357114 = Hospital System Supply Identifier | 1082631 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301210 12X10MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1356553","type":"LOCAL"},{"code":"1082693","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1356553 = Hospital System Supply Identifier | 1082693 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301215 12X15MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1357004","type":"LOCAL"},{"code":"1082844","type":"LOCAL"}],"standard_charges":[{"gross_charge":1598.85,"discounted_cash":559.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1357004 = Hospital System Supply Identifier | 1082844 = Lawson ID"}]},{"description":"DISC - COLLAR CERV PHILA 2P MED 4.25","code_information":[{"code":"Sx00-1741-011","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"836004","type":"LOCAL"},{"code":"106761","type":"LOCAL"}],"standard_charges":[{"gross_charge":117.61,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 836004 = Hospital System Supply Identifier | 106761 = Lawson ID"}]},{"description":"REAMER FLEX IM 12.5MM DIA","code_information":[{"code":"Sx00-2228-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"411217","type":"LOCAL"},{"code":"459165","type":"LOCAL"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411217 = Hospital System Supply Identifier | 459165 = Lawson ID"}]},{"description":"REAMER FLEX IM 13MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"411218","type":"LOCAL"},{"code":"459166","type":"LOCAL"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411218 = Hospital System Supply Identifier | 459166 = Lawson ID"}]},{"description":"REAMER FLEX IM 13.5MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"411219","type":"LOCAL"},{"code":"459167","type":"LOCAL"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411219 = Hospital System Supply Identifier | 459167 = Lawson ID"}]},{"description":"REAMER FLEX IM 14MM DIA","code_information":[{"code":"Sx00-2228-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"411220","type":"LOCAL"},{"code":"459168","type":"LOCAL"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":788.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411220 = Hospital System Supply Identifier | 459168 = Lawson ID"}]},{"description":"REAMER SURGICAL 24MM FLEXIBLE","code_information":[{"code":"Sx00-2228-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"35478","type":"LOCAL"},{"code":"158616","type":"LOCAL"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 35478 = Hospital System Supply Identifier | 158616 = Lawson ID"}]},{"description":"INST CABLE-READY SET","code_information":[{"code":"Sx00-2232-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"202248","type":"LOCAL"},{"code":"452346","type":"LOCAL"}],"standard_charges":[{"gross_charge":26754.0,"discounted_cash":9363.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 202248 = Hospital System Supply Identifier | 452346 = Lawson ID"}]},{"description":"BUTTON HEX 2.5MM 2232-01-25","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408802","type":"LOCAL"},{"code":"339930","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408802 = Hospital System Supply Identifier | 339930 = Lawson ID"}]},{"description":"BUTTON HEX SS 5.0MM","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410423","type":"LOCAL"},{"code":"416866","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410423 = Hospital System Supply Identifier | 416866 = Lawson ID"}]},{"description":"BUTTON HEX SNGL 5.0MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"411310","type":"LOCAL"},{"code":"462060","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 411310 = Hospital System Supply Identifier | 462060 = Lawson ID"}]},{"description":"BUTTON BONE GRIP CABLE READY 00223200225 TITANIUM 2.5MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1161459","type":"LOCAL"},{"code":"1002959","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 1161459 = Hospital System Supply Identifier | 1002959 = Lawson ID"}]},{"description":"CBL DEV GTR LNG W/O CBL","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"17233","type":"LOCAL"},{"code":"144555","type":"LOCAL"}],"standard_charges":[{"gross_charge":6772.5,"discounted_cash":2370.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17233 = Hospital System Supply Identifier | 144555 = Lawson ID"}]},{"description":"IMP CABLE SS 1.3 X 560MM","code_information":[{"code":"Sx00-2232-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408073","type":"LOCAL"},{"code":"245979","type":"LOCAL"}],"standard_charges":[{"gross_charge":1435.5,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408073 = Hospital System Supply Identifier | 245979 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-20","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"168183","type":"LOCAL"},{"code":"206449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1404.21,"discounted_cash":491.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 168183 = Hospital System Supply Identifier | 206449 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-19","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407864","type":"LOCAL"},{"code":"206450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1404.21,"discounted_cash":491.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407864 = Hospital System Supply Identifier | 206450 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-18","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407865","type":"LOCAL"},{"code":"206453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1404.21,"discounted_cash":491.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407865 = Hospital System Supply Identifier | 206453 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-21","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407866","type":"LOCAL"},{"code":"206454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1404.21,"discounted_cash":491.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407866 = Hospital System Supply Identifier | 206454 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X480MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407755","type":"LOCAL"},{"code":"205439","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407755 = Hospital System Supply Identifier | 205439 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X460MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407754","type":"LOCAL"},{"code":"205438","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407754 = Hospital System Supply Identifier | 205438 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X440MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407753","type":"LOCAL"},{"code":"205437","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407753 = Hospital System Supply Identifier | 205437 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X420MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407752","type":"LOCAL"},{"code":"205436","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407752 = Hospital System Supply Identifier | 205436 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X400MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407751","type":"LOCAL"},{"code":"205435","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407751 = Hospital System Supply Identifier | 205435 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X380MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407750","type":"LOCAL"},{"code":"205434","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407750 = Hospital System Supply Identifier | 205434 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X360MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407749","type":"LOCAL"},{"code":"205433","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407749 = Hospital System Supply Identifier | 205433 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X340MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407748","type":"LOCAL"},{"code":"205431","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407748 = Hospital System Supply Identifier | 205431 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X320MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407747","type":"LOCAL"},{"code":"205430","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407747 = Hospital System Supply Identifier | 205430 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X180MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407703","type":"LOCAL"},{"code":"205386","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407703 = Hospital System Supply Identifier | 205386 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X280MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407745","type":"LOCAL"},{"code":"205428","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407745 = Hospital System Supply Identifier | 205428 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X260MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407744","type":"LOCAL"},{"code":"205427","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407744 = Hospital System Supply Identifier | 205427 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X240MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407743","type":"LOCAL"},{"code":"205426","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407743 = Hospital System Supply Identifier | 205426 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X220MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407708","type":"LOCAL"},{"code":"205391","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407708 = Hospital System Supply Identifier | 205391 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X200MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407706","type":"LOCAL"},{"code":"205389","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407706 = Hospital System Supply Identifier | 205389 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X160MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407699","type":"LOCAL"},{"code":"205382","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407699 = Hospital System Supply Identifier | 205382 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X140MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407696","type":"LOCAL"},{"code":"205379","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407696 = Hospital System Supply Identifier | 205379 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X300MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407746","type":"LOCAL"},{"code":"205429","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407746 = Hospital System Supply Identifier | 205429 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X240MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407761","type":"LOCAL"},{"code":"205445","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407761 = Hospital System Supply Identifier | 205445 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X260MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407762","type":"LOCAL"},{"code":"205446","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407762 = Hospital System Supply Identifier | 205446 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X280MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407763","type":"LOCAL"},{"code":"205447","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407763 = Hospital System Supply Identifier | 205447 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X360MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407767","type":"LOCAL"},{"code":"205451","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407767 = Hospital System Supply Identifier | 205451 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X320MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407765","type":"LOCAL"},{"code":"205449","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407765 = Hospital System Supply Identifier | 205449 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X340MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407766","type":"LOCAL"},{"code":"205450","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407766 = Hospital System Supply Identifier | 205450 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X220MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407760","type":"LOCAL"},{"code":"205444","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407760 = Hospital System Supply Identifier | 205444 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X300MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407764","type":"LOCAL"},{"code":"205448","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407764 = Hospital System Supply Identifier | 205448 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X200MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407759","type":"LOCAL"},{"code":"205443","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407759 = Hospital System Supply Identifier | 205443 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X420MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407570","type":"LOCAL"},{"code":"205251","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407570 = Hospital System Supply Identifier | 205251 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X160MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407757","type":"LOCAL"},{"code":"205441","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407757 = Hospital System Supply Identifier | 205441 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X140MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407756","type":"LOCAL"},{"code":"205440","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407756 = Hospital System Supply Identifier | 205440 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X480MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407574","type":"LOCAL"},{"code":"205255","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407574 = Hospital System Supply Identifier | 205255 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X460MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407572","type":"LOCAL"},{"code":"205253","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407572 = Hospital System Supply Identifier | 205253 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X440MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407571","type":"LOCAL"},{"code":"205252","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407571 = Hospital System Supply Identifier | 205252 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X400MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407568","type":"LOCAL"},{"code":"205249","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407568 = Hospital System Supply Identifier | 205249 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X380MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407566","type":"LOCAL"},{"code":"205247","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407566 = Hospital System Supply Identifier | 205247 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X180MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407758","type":"LOCAL"},{"code":"205442","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407758 = Hospital System Supply Identifier | 205442 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X480MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407617","type":"LOCAL"},{"code":"205299","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407617 = Hospital System Supply Identifier | 205299 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X460MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407616","type":"LOCAL"},{"code":"205298","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407616 = Hospital System Supply Identifier | 205298 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X440MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407615","type":"LOCAL"},{"code":"205297","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407615 = Hospital System Supply Identifier | 205297 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X400MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407613","type":"LOCAL"},{"code":"205295","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407613 = Hospital System Supply Identifier | 205295 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X380MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407610","type":"LOCAL"},{"code":"205292","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407610 = Hospital System Supply Identifier | 205292 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X360MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407608","type":"LOCAL"},{"code":"205290","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407608 = Hospital System Supply Identifier | 205290 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X420MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407607","type":"LOCAL"},{"code":"205289","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407607 = Hospital System Supply Identifier | 205289 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X340MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407606","type":"LOCAL"},{"code":"205288","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407606 = Hospital System Supply Identifier | 205288 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X320MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407605","type":"LOCAL"},{"code":"205286","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407605 = Hospital System Supply Identifier | 205286 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X280MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407600","type":"LOCAL"},{"code":"205281","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407600 = Hospital System Supply Identifier | 205281 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X260MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407599","type":"LOCAL"},{"code":"205280","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407599 = Hospital System Supply Identifier | 205280 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X240MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407598","type":"LOCAL"},{"code":"205279","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407598 = Hospital System Supply Identifier | 205279 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X220MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407596","type":"LOCAL"},{"code":"205277","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407596 = Hospital System Supply Identifier | 205277 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X200MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407589","type":"LOCAL"},{"code":"205270","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407589 = Hospital System Supply Identifier | 205270 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X180MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407588","type":"LOCAL"},{"code":"205269","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407588 = Hospital System Supply Identifier | 205269 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X160MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407579","type":"LOCAL"},{"code":"205260","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407579 = Hospital System Supply Identifier | 205260 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X140MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407577","type":"LOCAL"},{"code":"205258","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407577 = Hospital System Supply Identifier | 205258 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X300MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407601","type":"LOCAL"},{"code":"205282","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407601 = Hospital System Supply Identifier | 205282 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X360MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407649","type":"LOCAL"},{"code":"205332","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407649 = Hospital System Supply Identifier | 205332 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X380MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407653","type":"LOCAL"},{"code":"205336","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407653 = Hospital System Supply Identifier | 205336 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X400MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407657","type":"LOCAL"},{"code":"205340","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407657 = Hospital System Supply Identifier | 205340 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X340MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407642","type":"LOCAL"},{"code":"205325","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407642 = Hospital System Supply Identifier | 205325 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X440MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407663","type":"LOCAL"},{"code":"205346","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407663 = Hospital System Supply Identifier | 205346 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X460MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407664","type":"LOCAL"},{"code":"205347","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407664 = Hospital System Supply Identifier | 205347 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X480MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407665","type":"LOCAL"},{"code":"205348","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407665 = Hospital System Supply Identifier | 205348 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X420MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407661","type":"LOCAL"},{"code":"205344","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407661 = Hospital System Supply Identifier | 205344 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X320MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407638","type":"LOCAL"},{"code":"205321","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407638 = Hospital System Supply Identifier | 205321 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X260MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407630","type":"LOCAL"},{"code":"205313","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407630 = Hospital System Supply Identifier | 205313 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X280MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407631","type":"LOCAL"},{"code":"205314","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407631 = Hospital System Supply Identifier | 205314 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X300MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407636","type":"LOCAL"},{"code":"205319","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407636 = Hospital System Supply Identifier | 205319 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X240MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407629","type":"LOCAL"},{"code":"205312","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407629 = Hospital System Supply Identifier | 205312 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X220MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407628","type":"LOCAL"},{"code":"205311","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407628 = Hospital System Supply Identifier | 205311 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X200MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407625","type":"LOCAL"},{"code":"205307","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407625 = Hospital System Supply Identifier | 205307 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X180MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407623","type":"LOCAL"},{"code":"205305","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407623 = Hospital System Supply Identifier | 205305 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X160MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407622","type":"LOCAL"},{"code":"205304","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407622 = Hospital System Supply Identifier | 205304 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X140MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407620","type":"LOCAL"},{"code":"205302","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407620 = Hospital System Supply Identifier | 205302 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X360MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407693","type":"LOCAL"},{"code":"205376","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407693 = Hospital System Supply Identifier | 205376 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X380MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407695","type":"LOCAL"},{"code":"205378","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407695 = Hospital System Supply Identifier | 205378 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X400MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407768","type":"LOCAL"},{"code":"205452","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407768 = Hospital System Supply Identifier | 205452 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X480MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407772","type":"LOCAL"},{"code":"205456","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407772 = Hospital System Supply Identifier | 205456 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X440MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407770","type":"LOCAL"},{"code":"205454","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407770 = Hospital System Supply Identifier | 205454 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X460MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407771","type":"LOCAL"},{"code":"205455","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407771 = Hospital System Supply Identifier | 205455 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X340MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407692","type":"LOCAL"},{"code":"205375","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407692 = Hospital System Supply Identifier | 205375 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X420MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407769","type":"LOCAL"},{"code":"205453","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407769 = Hospital System Supply Identifier | 205453 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X320MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407688","type":"LOCAL"},{"code":"205371","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407688 = Hospital System Supply Identifier | 205371 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X300MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407687","type":"LOCAL"},{"code":"205370","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407687 = Hospital System Supply Identifier | 205370 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X280MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407686","type":"LOCAL"},{"code":"205369","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407686 = Hospital System Supply Identifier | 205369 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X260MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407685","type":"LOCAL"},{"code":"205368","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407685 = Hospital System Supply Identifier | 205368 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X240MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407678","type":"LOCAL"},{"code":"205361","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407678 = Hospital System Supply Identifier | 205361 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X220MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407677","type":"LOCAL"},{"code":"205360","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407677 = Hospital System Supply Identifier | 205360 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X200MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407672","type":"LOCAL"},{"code":"205355","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407672 = Hospital System Supply Identifier | 205355 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X180MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407668","type":"LOCAL"},{"code":"205351","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407668 = Hospital System Supply Identifier | 205351 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X160MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407667","type":"LOCAL"},{"code":"205350","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407667 = Hospital System Supply Identifier | 205350 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X140MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407666","type":"LOCAL"},{"code":"205349","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407666 = Hospital System Supply Identifier | 205349 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X460MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407789","type":"LOCAL"},{"code":"205473","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407789 = Hospital System Supply Identifier | 205473 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X440MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407788","type":"LOCAL"},{"code":"205472","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407788 = Hospital System Supply Identifier | 205472 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X420MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407787","type":"LOCAL"},{"code":"205471","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407787 = Hospital System Supply Identifier | 205471 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X480MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407790","type":"LOCAL"},{"code":"205474","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407790 = Hospital System Supply Identifier | 205474 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X380MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407785","type":"LOCAL"},{"code":"205469","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407785 = Hospital System Supply Identifier | 205469 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X360MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407784","type":"LOCAL"},{"code":"205468","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407784 = Hospital System Supply Identifier | 205468 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X340MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407783","type":"LOCAL"},{"code":"205467","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407783 = Hospital System Supply Identifier | 205467 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X320MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407782","type":"LOCAL"},{"code":"205466","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407782 = Hospital System Supply Identifier | 205466 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X400MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407786","type":"LOCAL"},{"code":"205470","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407786 = Hospital System Supply Identifier | 205470 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X280MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407780","type":"LOCAL"},{"code":"205464","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407780 = Hospital System Supply Identifier | 205464 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X260MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407779","type":"LOCAL"},{"code":"205463","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407779 = Hospital System Supply Identifier | 205463 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X240MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407778","type":"LOCAL"},{"code":"205462","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407778 = Hospital System Supply Identifier | 205462 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X220MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407777","type":"LOCAL"},{"code":"205461","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407777 = Hospital System Supply Identifier | 205461 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X200MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407776","type":"LOCAL"},{"code":"205460","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407776 = Hospital System Supply Identifier | 205460 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X180MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407775","type":"LOCAL"},{"code":"205459","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407775 = Hospital System Supply Identifier | 205459 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X160MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407774","type":"LOCAL"},{"code":"205458","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407774 = Hospital System Supply Identifier | 205458 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X140MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407773","type":"LOCAL"},{"code":"205457","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407773 = Hospital System Supply Identifier | 205457 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X300MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407781","type":"LOCAL"},{"code":"205465","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407781 = Hospital System Supply Identifier | 205465 = Lawson ID"}]},{"description":"NUT CORTICAL LOCK 2240-50","code_information":[{"code":"Sx00-2240-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407812","type":"LOCAL"},{"code":"205508","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.9,"discounted_cash":258.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407812 = Hospital System Supply Identifier | 205508 = Lawson ID"}]},{"description":"DISC - BIT DRILL PROX TIP 5.0 MM","code_information":[{"code":"Sx00-2241-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"408248","type":"LOCAL"},{"code":"303893","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.4,"discounted_cash":258.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408248 = Hospital System Supply Identifier | 303893 = Lawson ID"}]},{"description":"CAP NAIL FLUSH","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407366","type":"LOCAL"},{"code":"146487","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407366 = Hospital System Supply Identifier | 146487 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 5MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17380","type":"LOCAL"},{"code":"146488","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17380 = Hospital System Supply Identifier | 146488 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 10MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407367","type":"LOCAL"},{"code":"146489","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407367 = Hospital System Supply Identifier | 146489 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 15MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407368","type":"LOCAL"},{"code":"146490","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407368 = Hospital System Supply Identifier | 146490 = Lawson ID"}]},{"description":"NO USAGE - WASHER ORTHO 13 MM M/DN","code_information":[{"code":"Sx00-2252-002","type":"CDM"},{"code":"270","type":"RC"},{"code":"407810","type":"LOCAL"},{"code":"205506","type":"LOCAL"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":115.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407810 = Hospital System Supply Identifier | 205506 = Lawson ID"}]},{"description":"CAP NAIL HUM LCK","code_information":[{"code":"Sx00-2252-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407811","type":"LOCAL"},{"code":"205507","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407811 = Hospital System Supply Identifier | 205507 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X60MM","code_information":[{"code":"Sx00-2252-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407369","type":"LOCAL"},{"code":"146491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407369 = Hospital System Supply Identifier | 146491 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X65MM","code_information":[{"code":"Sx00-2252-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407370","type":"LOCAL"},{"code":"146492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407370 = Hospital System Supply Identifier | 146492 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X70MM","code_information":[{"code":"Sx00-2252-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407371","type":"LOCAL"},{"code":"146493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407371 = Hospital System Supply Identifier | 146493 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X75MM","code_information":[{"code":"Sx00-2252-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407372","type":"LOCAL"},{"code":"146494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407372 = Hospital System Supply Identifier | 146494 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X80MM","code_information":[{"code":"Sx00-2252-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407373","type":"LOCAL"},{"code":"146495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407373 = Hospital System Supply Identifier | 146495 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X85MM","code_information":[{"code":"Sx00-2252-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407374","type":"LOCAL"},{"code":"146496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407374 = Hospital System Supply Identifier | 146496 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X90MM","code_information":[{"code":"Sx00-2252-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17381","type":"LOCAL"},{"code":"146497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17381 = Hospital System Supply Identifier | 146497 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X95MM","code_information":[{"code":"Sx00-2252-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17382","type":"LOCAL"},{"code":"146498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17382 = Hospital System Supply Identifier | 146498 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X100MM","code_information":[{"code":"Sx00-2252-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407375","type":"LOCAL"},{"code":"146499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407375 = Hospital System Supply Identifier | 146499 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X105MM","code_information":[{"code":"Sx00-2252-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407376","type":"LOCAL"},{"code":"146500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407376 = Hospital System Supply Identifier | 146500 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X110MM","code_information":[{"code":"Sx00-2252-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407377","type":"LOCAL"},{"code":"146501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407377 = Hospital System Supply Identifier | 146501 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X115MM","code_information":[{"code":"Sx00-2252-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407378","type":"LOCAL"},{"code":"146502","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407378 = Hospital System Supply Identifier | 146502 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X120MM","code_information":[{"code":"Sx00-2252-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407379","type":"LOCAL"},{"code":"146503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407379 = Hospital System Supply Identifier | 146503 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X125MM","code_information":[{"code":"Sx00-2252-125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407380","type":"LOCAL"},{"code":"146504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407380 = Hospital System Supply Identifier | 146504 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X130MM","code_information":[{"code":"Sx00-2252-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407381","type":"LOCAL"},{"code":"146505","type":"LOCAL"}],"standard_charges":[{"gross_charge":1294.67,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407381 = Hospital System Supply Identifier | 146505 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407604","type":"LOCAL"},{"code":"205285","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407604 = Hospital System Supply Identifier | 205285 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407592","type":"LOCAL"},{"code":"205273","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407592 = Hospital System Supply Identifier | 205273 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407583","type":"LOCAL"},{"code":"205264","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407583 = Hospital System Supply Identifier | 205264 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407562","type":"LOCAL"},{"code":"205243","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407562 = Hospital System Supply Identifier | 205243 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407551","type":"LOCAL"},{"code":"205232","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407551 = Hospital System Supply Identifier | 205232 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407573","type":"LOCAL"},{"code":"205254","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407573 = Hospital System Supply Identifier | 205254 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407609","type":"LOCAL"},{"code":"205291","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407609 = Hospital System Supply Identifier | 205291 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407552","type":"LOCAL"},{"code":"205233","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407552 = Hospital System Supply Identifier | 205233 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407563","type":"LOCAL"},{"code":"205244","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407563 = Hospital System Supply Identifier | 205244 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407575","type":"LOCAL"},{"code":"205256","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407575 = Hospital System Supply Identifier | 205256 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407584","type":"LOCAL"},{"code":"205265","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407584 = Hospital System Supply Identifier | 205265 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407593","type":"LOCAL"},{"code":"205274","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407593 = Hospital System Supply Identifier | 205274 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407611","type":"LOCAL"},{"code":"205293","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407611 = Hospital System Supply Identifier | 205293 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407576","type":"LOCAL"},{"code":"205257","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407576 = Hospital System Supply Identifier | 205257 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407621","type":"LOCAL"},{"code":"205303","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407621 = Hospital System Supply Identifier | 205303 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407594","type":"LOCAL"},{"code":"205275","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407594 = Hospital System Supply Identifier | 205275 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407553","type":"LOCAL"},{"code":"205234","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407553 = Hospital System Supply Identifier | 205234 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407564","type":"LOCAL"},{"code":"205245","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407564 = Hospital System Supply Identifier | 205245 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407585","type":"LOCAL"},{"code":"205266","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407585 = Hospital System Supply Identifier | 205266 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407555","type":"LOCAL"},{"code":"205236","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407555 = Hospital System Supply Identifier | 205236 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407565","type":"LOCAL"},{"code":"205246","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407565 = Hospital System Supply Identifier | 205246 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407578","type":"LOCAL"},{"code":"205259","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407578 = Hospital System Supply Identifier | 205259 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407586","type":"LOCAL"},{"code":"205267","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407586 = Hospital System Supply Identifier | 205267 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407595","type":"LOCAL"},{"code":"205276","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407595 = Hospital System Supply Identifier | 205276 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407612","type":"LOCAL"},{"code":"205294","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407612 = Hospital System Supply Identifier | 205294 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407624","type":"LOCAL"},{"code":"205306","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407624 = Hospital System Supply Identifier | 205306 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407634","type":"LOCAL"},{"code":"205317","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407634 = Hospital System Supply Identifier | 205317 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407648","type":"LOCAL"},{"code":"205331","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407648 = Hospital System Supply Identifier | 205331 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407650","type":"LOCAL"},{"code":"205333","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407650 = Hospital System Supply Identifier | 205333 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407635","type":"LOCAL"},{"code":"205318","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407635 = Hospital System Supply Identifier | 205318 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407626","type":"LOCAL"},{"code":"205308","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407626 = Hospital System Supply Identifier | 205308 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407614","type":"LOCAL"},{"code":"205296","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407614 = Hospital System Supply Identifier | 205296 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407382","type":"LOCAL"},{"code":"146506","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407382 = Hospital System Supply Identifier | 146506 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407587","type":"LOCAL"},{"code":"205268","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407587 = Hospital System Supply Identifier | 205268 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407554","type":"LOCAL"},{"code":"205235","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407554 = Hospital System Supply Identifier | 205235 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407388","type":"LOCAL"},{"code":"146512","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407388 = Hospital System Supply Identifier | 146512 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407597","type":"LOCAL"},{"code":"205278","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407597 = Hospital System Supply Identifier | 205278 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407627","type":"LOCAL"},{"code":"205309","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407627 = Hospital System Supply Identifier | 205309 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407651","type":"LOCAL"},{"code":"205334","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407651 = Hospital System Supply Identifier | 205334 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407637","type":"LOCAL"},{"code":"205320","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407637 = Hospital System Supply Identifier | 205320 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407556","type":"LOCAL"},{"code":"205237","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407556 = Hospital System Supply Identifier | 205237 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407383","type":"LOCAL"},{"code":"146507","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407383 = Hospital System Supply Identifier | 146507 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407400","type":"LOCAL"},{"code":"146524","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407400 = Hospital System Supply Identifier | 146524 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407394","type":"LOCAL"},{"code":"146518","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407394 = Hospital System Supply Identifier | 146518 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407389","type":"LOCAL"},{"code":"146513","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407389 = Hospital System Supply Identifier | 146513 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407405","type":"LOCAL"},{"code":"146530","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407405 = Hospital System Supply Identifier | 146530 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407652","type":"LOCAL"},{"code":"205335","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407652 = Hospital System Supply Identifier | 205335 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407639","type":"LOCAL"},{"code":"205322","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407639 = Hospital System Supply Identifier | 205322 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407557","type":"LOCAL"},{"code":"205238","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407557 = Hospital System Supply Identifier | 205238 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407412","type":"LOCAL"},{"code":"146537","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407412 = Hospital System Supply Identifier | 146537 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407406","type":"LOCAL"},{"code":"146531","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407406 = Hospital System Supply Identifier | 146531 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407395","type":"LOCAL"},{"code":"146519","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407395 = Hospital System Supply Identifier | 146519 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407390","type":"LOCAL"},{"code":"146514","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407390 = Hospital System Supply Identifier | 146514 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407384","type":"LOCAL"},{"code":"146508","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407384 = Hospital System Supply Identifier | 146508 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407401","type":"LOCAL"},{"code":"146525","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407401 = Hospital System Supply Identifier | 146525 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407558","type":"LOCAL"},{"code":"205239","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407558 = Hospital System Supply Identifier | 205239 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407654","type":"LOCAL"},{"code":"205337","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407654 = Hospital System Supply Identifier | 205337 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407640","type":"LOCAL"},{"code":"205323","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407640 = Hospital System Supply Identifier | 205323 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407413","type":"LOCAL"},{"code":"146538","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407413 = Hospital System Supply Identifier | 146538 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407385","type":"LOCAL"},{"code":"146509","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407385 = Hospital System Supply Identifier | 146509 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17383","type":"LOCAL"},{"code":"146526","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17383 = Hospital System Supply Identifier | 146526 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407391","type":"LOCAL"},{"code":"146515","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407391 = Hospital System Supply Identifier | 146515 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407407","type":"LOCAL"},{"code":"146532","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407407 = Hospital System Supply Identifier | 146532 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407396","type":"LOCAL"},{"code":"146520","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407396 = Hospital System Supply Identifier | 146520 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407386","type":"LOCAL"},{"code":"146510","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407386 = Hospital System Supply Identifier | 146510 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407392","type":"LOCAL"},{"code":"146516","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407392 = Hospital System Supply Identifier | 146516 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407397","type":"LOCAL"},{"code":"146521","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407397 = Hospital System Supply Identifier | 146521 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407402","type":"LOCAL"},{"code":"146527","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407402 = Hospital System Supply Identifier | 146527 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407414","type":"LOCAL"},{"code":"146539","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407414 = Hospital System Supply Identifier | 146539 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407559","type":"LOCAL"},{"code":"205240","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407559 = Hospital System Supply Identifier | 205240 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407641","type":"LOCAL"},{"code":"205324","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407641 = Hospital System Supply Identifier | 205324 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407655","type":"LOCAL"},{"code":"205338","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407655 = Hospital System Supply Identifier | 205338 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407408","type":"LOCAL"},{"code":"146533","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407408 = Hospital System Supply Identifier | 146533 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407656","type":"LOCAL"},{"code":"205339","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407656 = Hospital System Supply Identifier | 205339 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407415","type":"LOCAL"},{"code":"146540","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407415 = Hospital System Supply Identifier | 146540 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407643","type":"LOCAL"},{"code":"205326","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407643 = Hospital System Supply Identifier | 205326 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407560","type":"LOCAL"},{"code":"205241","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407560 = Hospital System Supply Identifier | 205241 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407403","type":"LOCAL"},{"code":"146528","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407403 = Hospital System Supply Identifier | 146528 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407398","type":"LOCAL"},{"code":"146522","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407398 = Hospital System Supply Identifier | 146522 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407393","type":"LOCAL"},{"code":"146517","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407393 = Hospital System Supply Identifier | 146517 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407387","type":"LOCAL"},{"code":"146511","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407387 = Hospital System Supply Identifier | 146511 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407409","type":"LOCAL"},{"code":"146534","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407409 = Hospital System Supply Identifier | 146534 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407399","type":"LOCAL"},{"code":"146523","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407399 = Hospital System Supply Identifier | 146523 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407404","type":"LOCAL"},{"code":"146529","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407404 = Hospital System Supply Identifier | 146529 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407410","type":"LOCAL"},{"code":"146535","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407410 = Hospital System Supply Identifier | 146535 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407416","type":"LOCAL"},{"code":"146541","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407416 = Hospital System Supply Identifier | 146541 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407561","type":"LOCAL"},{"code":"205242","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407561 = Hospital System Supply Identifier | 205242 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407567","type":"LOCAL"},{"code":"205248","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407567 = Hospital System Supply Identifier | 205248 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407580","type":"LOCAL"},{"code":"205261","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407580 = Hospital System Supply Identifier | 205261 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407644","type":"LOCAL"},{"code":"205327","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407644 = Hospital System Supply Identifier | 205327 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407658","type":"LOCAL"},{"code":"205341","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407658 = Hospital System Supply Identifier | 205341 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407602","type":"LOCAL"},{"code":"205283","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407602 = Hospital System Supply Identifier | 205283 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407645","type":"LOCAL"},{"code":"205328","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407645 = Hospital System Supply Identifier | 205328 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407590","type":"LOCAL"},{"code":"205271","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407590 = Hospital System Supply Identifier | 205271 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407659","type":"LOCAL"},{"code":"205342","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407659 = Hospital System Supply Identifier | 205342 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407569","type":"LOCAL"},{"code":"205250","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407569 = Hospital System Supply Identifier | 205250 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407417","type":"LOCAL"},{"code":"146542","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407417 = Hospital System Supply Identifier | 146542 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407411","type":"LOCAL"},{"code":"146536","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407411 = Hospital System Supply Identifier | 146536 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407581","type":"LOCAL"},{"code":"205262","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407581 = Hospital System Supply Identifier | 205262 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407660","type":"LOCAL"},{"code":"205343","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407660 = Hospital System Supply Identifier | 205343 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407632","type":"LOCAL"},{"code":"205315","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407632 = Hospital System Supply Identifier | 205315 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407618","type":"LOCAL"},{"code":"205300","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407618 = Hospital System Supply Identifier | 205300 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407646","type":"LOCAL"},{"code":"205329","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407646 = Hospital System Supply Identifier | 205329 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407591","type":"LOCAL"},{"code":"205272","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407591 = Hospital System Supply Identifier | 205272 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407582","type":"LOCAL"},{"code":"205263","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407582 = Hospital System Supply Identifier | 205263 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407603","type":"LOCAL"},{"code":"205284","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407603 = Hospital System Supply Identifier | 205284 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407619","type":"LOCAL"},{"code":"205301","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407619 = Hospital System Supply Identifier | 205301 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407633","type":"LOCAL"},{"code":"205316","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407633 = Hospital System Supply Identifier | 205316 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407647","type":"LOCAL"},{"code":"205330","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407647 = Hospital System Supply Identifier | 205330 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407662","type":"LOCAL"},{"code":"205345","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.48,"discounted_cash":1138.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407662 = Hospital System Supply Identifier | 205345 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408803","type":"LOCAL"},{"code":"339933","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408803 = Hospital System Supply Identifier | 339933 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407448","type":"LOCAL"},{"code":"146575","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407448 = Hospital System Supply Identifier | 146575 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407463","type":"LOCAL"},{"code":"146590","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407463 = Hospital System Supply Identifier | 146590 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407474","type":"LOCAL"},{"code":"146605","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407474 = Hospital System Supply Identifier | 146605 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X22.5M","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409830","type":"LOCAL"},{"code":"407369","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409830 = Hospital System Supply Identifier | 407369 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X22.5","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407885","type":"LOCAL"},{"code":"206933","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407885 = Hospital System Supply Identifier | 206933 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X22.5","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407872","type":"LOCAL"},{"code":"206919","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407872 = Hospital System Supply Identifier | 206919 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407449","type":"LOCAL"},{"code":"146576","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407449 = Hospital System Supply Identifier | 146576 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407464","type":"LOCAL"},{"code":"146591","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407464 = Hospital System Supply Identifier | 146591 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407475","type":"LOCAL"},{"code":"146606","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407475 = Hospital System Supply Identifier | 146606 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408804","type":"LOCAL"},{"code":"339934","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408804 = Hospital System Supply Identifier | 339934 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X27.5","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407886","type":"LOCAL"},{"code":"206934","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407886 = Hospital System Supply Identifier | 206934 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X27.5","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407893","type":"LOCAL"},{"code":"206941","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":191.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407893 = Hospital System Supply Identifier | 206941 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X27.5M","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409831","type":"LOCAL"},{"code":"407370","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409831 = Hospital System Supply Identifier | 407370 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408805","type":"LOCAL"},{"code":"339935","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408805 = Hospital System Supply Identifier | 339935 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102021","type":"LOCAL"},{"code":"146607","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102021 = Hospital System Supply Identifier | 146607 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407465","type":"LOCAL"},{"code":"146592","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407465 = Hospital System Supply Identifier | 146592 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407450","type":"LOCAL"},{"code":"146577","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407450 = Hospital System Supply Identifier | 146577 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X32.5","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407873","type":"LOCAL"},{"code":"206920","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407873 = Hospital System Supply Identifier | 206920 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X32.5","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407891","type":"LOCAL"},{"code":"206939","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407891 = Hospital System Supply Identifier | 206939 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X32.5M","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409832","type":"LOCAL"},{"code":"407371","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409832 = Hospital System Supply Identifier | 407371 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407451","type":"LOCAL"},{"code":"146578","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407451 = Hospital System Supply Identifier | 146578 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100908","type":"LOCAL"},{"code":"146593","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 100908 = Hospital System Supply Identifier | 146593 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102022","type":"LOCAL"},{"code":"146608","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102022 = Hospital System Supply Identifier | 146608 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408806","type":"LOCAL"},{"code":"339936","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408806 = Hospital System Supply Identifier | 339936 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X37.5","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407892","type":"LOCAL"},{"code":"206940","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407892 = Hospital System Supply Identifier | 206940 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X37.5M","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409833","type":"LOCAL"},{"code":"407372","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409833 = Hospital System Supply Identifier | 407372 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X37.5","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407883","type":"LOCAL"},{"code":"206931","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407883 = Hospital System Supply Identifier | 206931 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407452","type":"LOCAL"},{"code":"146579","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407452 = Hospital System Supply Identifier | 146579 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102019","type":"LOCAL"},{"code":"146594","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102019 = Hospital System Supply Identifier | 146594 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102023","type":"LOCAL"},{"code":"146609","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102023 = Hospital System Supply Identifier | 146609 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408807","type":"LOCAL"},{"code":"339937","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408807 = Hospital System Supply Identifier | 339937 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X42.5","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407867","type":"LOCAL"},{"code":"206914","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407867 = Hospital System Supply Identifier | 206914 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X42.5","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407884","type":"LOCAL"},{"code":"206932","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":191.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407884 = Hospital System Supply Identifier | 206932 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X42.5M","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409834","type":"LOCAL"},{"code":"407373","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409834 = Hospital System Supply Identifier | 407373 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408808","type":"LOCAL"},{"code":"339938","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408808 = Hospital System Supply Identifier | 339938 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"17384","type":"LOCAL"},{"code":"146610","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 17384 = Hospital System Supply Identifier | 146610 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102020","type":"LOCAL"},{"code":"146595","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":191.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102020 = Hospital System Supply Identifier | 146595 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407453","type":"LOCAL"},{"code":"146580","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407453 = Hospital System Supply Identifier | 146580 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X47.5","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407868","type":"LOCAL"},{"code":"206915","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407868 = Hospital System Supply Identifier | 206915 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X47.5","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407874","type":"LOCAL"},{"code":"206921","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":191.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407874 = Hospital System Supply Identifier | 206921 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X47.5M","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409835","type":"LOCAL"},{"code":"407374","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409835 = Hospital System Supply Identifier | 407374 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407454","type":"LOCAL"},{"code":"146581","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407454 = Hospital System Supply Identifier | 146581 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100909","type":"LOCAL"},{"code":"146596","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":191.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 100909 = Hospital System Supply Identifier | 146596 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407476","type":"LOCAL"},{"code":"146611","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407476 = Hospital System Supply Identifier | 146611 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X52.5M","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409836","type":"LOCAL"},{"code":"407375","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409836 = Hospital System Supply Identifier | 407375 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X52.5","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407875","type":"LOCAL"},{"code":"206922","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407875 = Hospital System Supply Identifier | 206922 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X52.5","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407869","type":"LOCAL"},{"code":"206916","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407869 = Hospital System Supply Identifier | 206916 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408809","type":"LOCAL"},{"code":"339939","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408809 = Hospital System Supply Identifier | 339939 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407477","type":"LOCAL"},{"code":"146612","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407477 = Hospital System Supply Identifier | 146612 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407455","type":"LOCAL"},{"code":"146582","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407455 = Hospital System Supply Identifier | 146582 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407466","type":"LOCAL"},{"code":"146597","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407466 = Hospital System Supply Identifier | 146597 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X57.5","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407870","type":"LOCAL"},{"code":"206917","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407870 = Hospital System Supply Identifier | 206917 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X57.5","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407876","type":"LOCAL"},{"code":"206923","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407876 = Hospital System Supply Identifier | 206923 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X57.5M","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409837","type":"LOCAL"},{"code":"407376","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409837 = Hospital System Supply Identifier | 407376 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407456","type":"LOCAL"},{"code":"146583","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407456 = Hospital System Supply Identifier | 146583 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407467","type":"LOCAL"},{"code":"146598","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407467 = Hospital System Supply Identifier | 146598 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100910","type":"LOCAL"},{"code":"146613","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 100910 = Hospital System Supply Identifier | 146613 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408810","type":"LOCAL"},{"code":"339940","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408810 = Hospital System Supply Identifier | 339940 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X62.5","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407871","type":"LOCAL"},{"code":"206918","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407871 = Hospital System Supply Identifier | 206918 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X62.5","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407877","type":"LOCAL"},{"code":"206924","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407877 = Hospital System Supply Identifier | 206924 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X62.5M","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409838","type":"LOCAL"},{"code":"407377","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409838 = Hospital System Supply Identifier | 407377 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408811","type":"LOCAL"},{"code":"339941","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408811 = Hospital System Supply Identifier | 339941 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407457","type":"LOCAL"},{"code":"146584","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407457 = Hospital System Supply Identifier | 146584 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407468","type":"LOCAL"},{"code":"146599","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407468 = Hospital System Supply Identifier | 146599 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102024","type":"LOCAL"},{"code":"146614","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102024 = Hospital System Supply Identifier | 146614 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X67.5","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407887","type":"LOCAL"},{"code":"206935","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407887 = Hospital System Supply Identifier | 206935 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X67.5M","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409839","type":"LOCAL"},{"code":"407378","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409839 = Hospital System Supply Identifier | 407378 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X67.5","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407881","type":"LOCAL"},{"code":"206928","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407881 = Hospital System Supply Identifier | 206928 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407478","type":"LOCAL"},{"code":"146615","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407478 = Hospital System Supply Identifier | 146615 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408812","type":"LOCAL"},{"code":"339942","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408812 = Hospital System Supply Identifier | 339942 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407458","type":"LOCAL"},{"code":"146585","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407458 = Hospital System Supply Identifier | 146585 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407469","type":"LOCAL"},{"code":"146600","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407469 = Hospital System Supply Identifier | 146600 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X72.5","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407882","type":"LOCAL"},{"code":"206930","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407882 = Hospital System Supply Identifier | 206930 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X72.5","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407888","type":"LOCAL"},{"code":"206936","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407888 = Hospital System Supply Identifier | 206936 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X72.5M","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409840","type":"LOCAL"},{"code":"407379","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409840 = Hospital System Supply Identifier | 407379 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407459","type":"LOCAL"},{"code":"146586","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407459 = Hospital System Supply Identifier | 146586 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407470","type":"LOCAL"},{"code":"146601","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407470 = Hospital System Supply Identifier | 146601 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102025","type":"LOCAL"},{"code":"146616","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102025 = Hospital System Supply Identifier | 146616 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408813","type":"LOCAL"},{"code":"339943","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408813 = Hospital System Supply Identifier | 339943 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X77.5M","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409841","type":"LOCAL"},{"code":"407380","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409841 = Hospital System Supply Identifier | 407380 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X77.5","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407878","type":"LOCAL"},{"code":"206925","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407878 = Hospital System Supply Identifier | 206925 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X77.5","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407791","type":"LOCAL"},{"code":"205483","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407791 = Hospital System Supply Identifier | 205483 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407460","type":"LOCAL"},{"code":"146587","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407460 = Hospital System Supply Identifier | 146587 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407471","type":"LOCAL"},{"code":"146602","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407471 = Hospital System Supply Identifier | 146602 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407479","type":"LOCAL"},{"code":"146617","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407479 = Hospital System Supply Identifier | 146617 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408814","type":"LOCAL"},{"code":"339944","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408814 = Hospital System Supply Identifier | 339944 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X82.5","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407879","type":"LOCAL"},{"code":"206926","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407879 = Hospital System Supply Identifier | 206926 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X82.5","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407889","type":"LOCAL"},{"code":"206937","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407889 = Hospital System Supply Identifier | 206937 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X82.5M","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409842","type":"LOCAL"},{"code":"407381","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409842 = Hospital System Supply Identifier | 407381 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408815","type":"LOCAL"},{"code":"339945","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408815 = Hospital System Supply Identifier | 339945 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"102026","type":"LOCAL"},{"code":"146618","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 102026 = Hospital System Supply Identifier | 146618 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407472","type":"LOCAL"},{"code":"146603","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407472 = Hospital System Supply Identifier | 146603 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407461","type":"LOCAL"},{"code":"146588","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407461 = Hospital System Supply Identifier | 146588 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X87.5","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407880","type":"LOCAL"},{"code":"206927","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407880 = Hospital System Supply Identifier | 206927 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X87.5","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407890","type":"LOCAL"},{"code":"206938","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407890 = Hospital System Supply Identifier | 206938 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X87.5M","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409843","type":"LOCAL"},{"code":"407382","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409843 = Hospital System Supply Identifier | 407382 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407462","type":"LOCAL"},{"code":"146589","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407462 = Hospital System Supply Identifier | 146589 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407473","type":"LOCAL"},{"code":"146604","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407473 = Hospital System Supply Identifier | 146604 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"166618","type":"LOCAL"},{"code":"146619","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 166618 = Hospital System Supply Identifier | 146619 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408816","type":"LOCAL"},{"code":"339946","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408816 = Hospital System Supply Identifier | 339946 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X95","code_information":[{"code":"Sx00-2253-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407480","type":"LOCAL"},{"code":"146620","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407480 = Hospital System Supply Identifier | 146620 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X100","code_information":[{"code":"Sx00-2253-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407481","type":"LOCAL"},{"code":"146621","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":249.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407481 = Hospital System Supply Identifier | 146621 = Lawson ID"}]},{"description":"NAIL TIB SS 7X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407541","type":"LOCAL"},{"code":"203126","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407541 = Hospital System Supply Identifier | 203126 = Lawson ID"}]},{"description":"NAIL TIB SS 10X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407671","type":"LOCAL"},{"code":"205354","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407671 = Hospital System Supply Identifier | 205354 = Lawson ID"}]},{"description":"NAIL TIB SS 11X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407682","type":"LOCAL"},{"code":"205365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407682 = Hospital System Supply Identifier | 205365 = Lawson ID"}]},{"description":"NAIL TIB SS 6X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407830","type":"LOCAL"},{"code":"205528","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407830 = Hospital System Supply Identifier | 205528 = Lawson ID"}]},{"description":"NAIL TIB SS 8X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407837","type":"LOCAL"},{"code":"205536","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407837 = Hospital System Supply Identifier | 205536 = Lawson ID"}]},{"description":"NAIL TIB SS 9X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407843","type":"LOCAL"},{"code":"205569","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407843 = Hospital System Supply Identifier | 205569 = Lawson ID"}]},{"description":"NAIL TIB SS 9X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407844","type":"LOCAL"},{"code":"205570","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407844 = Hospital System Supply Identifier | 205570 = Lawson ID"}]},{"description":"NAIL TIB SS 6X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407831","type":"LOCAL"},{"code":"205529","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407831 = Hospital System Supply Identifier | 205529 = Lawson ID"}]},{"description":"NAIL TIB SS 7X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407813","type":"LOCAL"},{"code":"205509","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407813 = Hospital System Supply Identifier | 205509 = Lawson ID"}]},{"description":"NAIL TIB SS 8X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407838","type":"LOCAL"},{"code":"205537","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407838 = Hospital System Supply Identifier | 205537 = Lawson ID"}]},{"description":"NAIL TIB SS 11X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407683","type":"LOCAL"},{"code":"205366","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407683 = Hospital System Supply Identifier | 205366 = Lawson ID"}]},{"description":"NAIL TIB SS 12X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407701","type":"LOCAL"},{"code":"205384","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407701 = Hospital System Supply Identifier | 205384 = Lawson ID"}]},{"description":"NAIL TIB SS 10X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407673","type":"LOCAL"},{"code":"205356","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407673 = Hospital System Supply Identifier | 205356 = Lawson ID"}]},{"description":"NAIL TIB SS 10X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407674","type":"LOCAL"},{"code":"205357","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407674 = Hospital System Supply Identifier | 205357 = Lawson ID"}]},{"description":"NAIL TIB SS 11X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407684","type":"LOCAL"},{"code":"205367","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407684 = Hospital System Supply Identifier | 205367 = Lawson ID"}]},{"description":"NAIL TIB SS 12X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407702","type":"LOCAL"},{"code":"205385","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407702 = Hospital System Supply Identifier | 205385 = Lawson ID"}]},{"description":"NAIL TIB SS 13X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407713","type":"LOCAL"},{"code":"205396","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407713 = Hospital System Supply Identifier | 205396 = Lawson ID"}]},{"description":"NAIL TIB SS 7X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407814","type":"LOCAL"},{"code":"205510","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407814 = Hospital System Supply Identifier | 205510 = Lawson ID"}]},{"description":"NAIL TIB SS 6X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407832","type":"LOCAL"},{"code":"205530","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407832 = Hospital System Supply Identifier | 205530 = Lawson ID"}]},{"description":"NAIL TIB SS 8X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407839","type":"LOCAL"},{"code":"205538","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407839 = Hospital System Supply Identifier | 205538 = Lawson ID"}]},{"description":"NAIL TIB SS 9X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407845","type":"LOCAL"},{"code":"205571","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407845 = Hospital System Supply Identifier | 205571 = Lawson ID"}]},{"description":"NAIL TIB SS 9X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407841","type":"LOCAL"},{"code":"205540","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407841 = Hospital System Supply Identifier | 205540 = Lawson ID"}]},{"description":"NAIL TIB SS 8X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407840","type":"LOCAL"},{"code":"205539","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407840 = Hospital System Supply Identifier | 205539 = Lawson ID"}]},{"description":"NAIL TIB SS 6X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407833","type":"LOCAL"},{"code":"205531","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407833 = Hospital System Supply Identifier | 205531 = Lawson ID"}]},{"description":"NAIL TIB SS 7X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407815","type":"LOCAL"},{"code":"205511","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407815 = Hospital System Supply Identifier | 205511 = Lawson ID"}]},{"description":"NAIL TIB SS 15X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407732","type":"LOCAL"},{"code":"205415","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407732 = Hospital System Supply Identifier | 205415 = Lawson ID"}]},{"description":"NAIL TIB SS 11X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407689","type":"LOCAL"},{"code":"205372","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407689 = Hospital System Supply Identifier | 205372 = Lawson ID"}]},{"description":"NAIL TIB SS 13X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407714","type":"LOCAL"},{"code":"205397","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407714 = Hospital System Supply Identifier | 205397 = Lawson ID"}]},{"description":"NAIL TIB SS 12X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407704","type":"LOCAL"},{"code":"205387","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407704 = Hospital System Supply Identifier | 205387 = Lawson ID"}]},{"description":"NAIL TIB SS 10X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407675","type":"LOCAL"},{"code":"205358","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407675 = Hospital System Supply Identifier | 205358 = Lawson ID"}]},{"description":"NAIL TIB SS 14X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407721","type":"LOCAL"},{"code":"205404","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407721 = Hospital System Supply Identifier | 205404 = Lawson ID"}]},{"description":"NAIL TIB SS 15X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407733","type":"LOCAL"},{"code":"205416","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407733 = Hospital System Supply Identifier | 205416 = Lawson ID"}]},{"description":"NAIL TIB SS 9X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407836","type":"LOCAL"},{"code":"205535","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407836 = Hospital System Supply Identifier | 205535 = Lawson ID"}]},{"description":"NAIL TIB SS 8X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407842","type":"LOCAL"},{"code":"205541","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407842 = Hospital System Supply Identifier | 205541 = Lawson ID"}]},{"description":"NAIL TIB SS 7X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407816","type":"LOCAL"},{"code":"205512","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407816 = Hospital System Supply Identifier | 205512 = Lawson ID"}]},{"description":"NAIL TIB SS 14X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407722","type":"LOCAL"},{"code":"205405","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407722 = Hospital System Supply Identifier | 205405 = Lawson ID"}]},{"description":"NAIL TIB SS 10X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407676","type":"LOCAL"},{"code":"205359","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407676 = Hospital System Supply Identifier | 205359 = Lawson ID"}]},{"description":"NAIL TIB SS 12X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407705","type":"LOCAL"},{"code":"205388","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407705 = Hospital System Supply Identifier | 205388 = Lawson ID"}]},{"description":"NAIL TIB SS 11X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407690","type":"LOCAL"},{"code":"205373","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407690 = Hospital System Supply Identifier | 205373 = Lawson ID"}]},{"description":"NAIL TIB SS 6X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"82280","type":"LOCAL"},{"code":"162223","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 82280 = Hospital System Supply Identifier | 162223 = Lawson ID"}]},{"description":"NAIL TIB SS 13X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407715","type":"LOCAL"},{"code":"205398","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407715 = Hospital System Supply Identifier | 205398 = Lawson ID"}]},{"description":"NAIL TIB SS 6X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407824","type":"LOCAL"},{"code":"205522","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407824 = Hospital System Supply Identifier | 205522 = Lawson ID"}]},{"description":"NAIL TIB SS 7X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407817","type":"LOCAL"},{"code":"205513","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407817 = Hospital System Supply Identifier | 205513 = Lawson ID"}]},{"description":"NAIL TIB SS 15X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407734","type":"LOCAL"},{"code":"205417","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407734 = Hospital System Supply Identifier | 205417 = Lawson ID"}]},{"description":"NAIL TIB SS 14X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407723","type":"LOCAL"},{"code":"205406","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407723 = Hospital System Supply Identifier | 205406 = Lawson ID"}]},{"description":"NAIL TIB SS 13X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407716","type":"LOCAL"},{"code":"205399","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407716 = Hospital System Supply Identifier | 205399 = Lawson ID"}]},{"description":"NAIL TIB SS 11X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407691","type":"LOCAL"},{"code":"205374","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407691 = Hospital System Supply Identifier | 205374 = Lawson ID"}]},{"description":"NAIL TIB SS 10X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407429","type":"LOCAL"},{"code":"146554","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407429 = Hospital System Supply Identifier | 146554 = Lawson ID"}]},{"description":"NAIL TIB SS 9X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407424","type":"LOCAL"},{"code":"146549","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407424 = Hospital System Supply Identifier | 146549 = Lawson ID"}]},{"description":"NAIL TIB SS 8X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407418","type":"LOCAL"},{"code":"146543","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407418 = Hospital System Supply Identifier | 146543 = Lawson ID"}]},{"description":"NAIL TIB SS 12X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407707","type":"LOCAL"},{"code":"205390","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407707 = Hospital System Supply Identifier | 205390 = Lawson ID"}]},{"description":"NAIL TIB SS 14X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407724","type":"LOCAL"},{"code":"205407","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407724 = Hospital System Supply Identifier | 205407 = Lawson ID"}]},{"description":"NAIL TIB SS 6X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407825","type":"LOCAL"},{"code":"205523","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407825 = Hospital System Supply Identifier | 205523 = Lawson ID"}]},{"description":"NAIL TIB SS 7X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407818","type":"LOCAL"},{"code":"205514","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407818 = Hospital System Supply Identifier | 205514 = Lawson ID"}]},{"description":"NAIL TIB SS 15X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407735","type":"LOCAL"},{"code":"205418","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407735 = Hospital System Supply Identifier | 205418 = Lawson ID"}]},{"description":"NAIL TIB SS 13X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407443","type":"LOCAL"},{"code":"146570","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407443 = Hospital System Supply Identifier | 146570 = Lawson ID"}]},{"description":"NAIL TIB SS 10X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407365","type":"LOCAL"},{"code":"145989","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407365 = Hospital System Supply Identifier | 145989 = Lawson ID"}]},{"description":"NAIL TIB SS 11X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407433","type":"LOCAL"},{"code":"146560","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407433 = Hospital System Supply Identifier | 146560 = Lawson ID"}]},{"description":"NAIL TIB SS 8X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407419","type":"LOCAL"},{"code":"146544","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407419 = Hospital System Supply Identifier | 146544 = Lawson ID"}]},{"description":"NAIL TIB SS 12X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407438","type":"LOCAL"},{"code":"146565","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407438 = Hospital System Supply Identifier | 146565 = Lawson ID"}]},{"description":"NAIL TIB SS 9X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407425","type":"LOCAL"},{"code":"146550","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407425 = Hospital System Supply Identifier | 146550 = Lawson ID"}]},{"description":"NAIL TIB SS 8X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407420","type":"LOCAL"},{"code":"146545","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407420 = Hospital System Supply Identifier | 146545 = Lawson ID"}]},{"description":"NAIL TIB SS 9X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407426","type":"LOCAL"},{"code":"146551","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407426 = Hospital System Supply Identifier | 146551 = Lawson ID"}]},{"description":"NAIL TIB SS 10X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407430","type":"LOCAL"},{"code":"146556","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407430 = Hospital System Supply Identifier | 146556 = Lawson ID"}]},{"description":"NAIL TIB SS 11X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407434","type":"LOCAL"},{"code":"146561","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407434 = Hospital System Supply Identifier | 146561 = Lawson ID"}]},{"description":"NAIL TIB SS 12X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407439","type":"LOCAL"},{"code":"146566","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407439 = Hospital System Supply Identifier | 146566 = Lawson ID"}]},{"description":"NAIL TIB SS 13X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407444","type":"LOCAL"},{"code":"146571","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407444 = Hospital System Supply Identifier | 146571 = Lawson ID"}]},{"description":"NAIL TIB SS 14X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407725","type":"LOCAL"},{"code":"205408","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407725 = Hospital System Supply Identifier | 205408 = Lawson ID"}]},{"description":"NAIL TIB SS 15X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407736","type":"LOCAL"},{"code":"205419","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407736 = Hospital System Supply Identifier | 205419 = Lawson ID"}]},{"description":"NAIL TIB SS 7X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407819","type":"LOCAL"},{"code":"205515","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407819 = Hospital System Supply Identifier | 205515 = Lawson ID"}]},{"description":"NAIL TIB SS 6X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407826","type":"LOCAL"},{"code":"205524","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407826 = Hospital System Supply Identifier | 205524 = Lawson ID"}]},{"description":"NAIL TIB SS 14X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407726","type":"LOCAL"},{"code":"205409","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407726 = Hospital System Supply Identifier | 205409 = Lawson ID"}]},{"description":"NAIL TIB SS 6X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407827","type":"LOCAL"},{"code":"205525","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407827 = Hospital System Supply Identifier | 205525 = Lawson ID"}]},{"description":"NAIL TIB SS 7X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407820","type":"LOCAL"},{"code":"205517","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407820 = Hospital System Supply Identifier | 205517 = Lawson ID"}]},{"description":"NAIL TIB SS 15X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407737","type":"LOCAL"},{"code":"205420","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407737 = Hospital System Supply Identifier | 205420 = Lawson ID"}]},{"description":"NAIL TIB SS 9X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407495","type":"LOCAL"},{"code":"148332","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407495 = Hospital System Supply Identifier | 148332 = Lawson ID"}]},{"description":"NAIL TIB SS 12X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407440","type":"LOCAL"},{"code":"146567","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407440 = Hospital System Supply Identifier | 146567 = Lawson ID"}]},{"description":"NAIL TIB SS 11X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407435","type":"LOCAL"},{"code":"146562","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407435 = Hospital System Supply Identifier | 146562 = Lawson ID"}]},{"description":"NAIL TIB SS 10X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407431","type":"LOCAL"},{"code":"146557","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407431 = Hospital System Supply Identifier | 146557 = Lawson ID"}]},{"description":"NAIL TIB SS 8X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407421","type":"LOCAL"},{"code":"146546","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407421 = Hospital System Supply Identifier | 146546 = Lawson ID"}]},{"description":"NAIL TIB SS 13X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407445","type":"LOCAL"},{"code":"146572","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407445 = Hospital System Supply Identifier | 146572 = Lawson ID"}]},{"description":"NAIL TIB SS 12X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407441","type":"LOCAL"},{"code":"146568","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407441 = Hospital System Supply Identifier | 146568 = Lawson ID"}]},{"description":"NAIL TIB SS 8X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407422","type":"LOCAL"},{"code":"146547","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407422 = Hospital System Supply Identifier | 146547 = Lawson ID"}]},{"description":"NAIL TIB SS 9X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407427","type":"LOCAL"},{"code":"146552","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407427 = Hospital System Supply Identifier | 146552 = Lawson ID"}]},{"description":"NAIL TIB SS 10X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407432","type":"LOCAL"},{"code":"146558","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407432 = Hospital System Supply Identifier | 146558 = Lawson ID"}]},{"description":"NAIL TIB SS 11X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407436","type":"LOCAL"},{"code":"146563","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407436 = Hospital System Supply Identifier | 146563 = Lawson ID"}]},{"description":"NAIL TIB SS 13X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407446","type":"LOCAL"},{"code":"146573","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407446 = Hospital System Supply Identifier | 146573 = Lawson ID"}]},{"description":"NAIL TIB SS 14X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407727","type":"LOCAL"},{"code":"205410","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407727 = Hospital System Supply Identifier | 205410 = Lawson ID"}]},{"description":"NAIL TIB SS 15X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407738","type":"LOCAL"},{"code":"205421","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407738 = Hospital System Supply Identifier | 205421 = Lawson ID"}]},{"description":"NAIL TIB SS 7X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407821","type":"LOCAL"},{"code":"205519","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407821 = Hospital System Supply Identifier | 205519 = Lawson ID"}]},{"description":"NAIL TIB SS 6X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407828","type":"LOCAL"},{"code":"205526","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407828 = Hospital System Supply Identifier | 205526 = Lawson ID"}]},{"description":"NAIL TIB SS 14X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407728","type":"LOCAL"},{"code":"205411","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407728 = Hospital System Supply Identifier | 205411 = Lawson ID"}]},{"description":"NAIL TIB SS 13X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407447","type":"LOCAL"},{"code":"146574","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407447 = Hospital System Supply Identifier | 146574 = Lawson ID"}]},{"description":"NAIL TIB SS 7X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407822","type":"LOCAL"},{"code":"205520","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407822 = Hospital System Supply Identifier | 205520 = Lawson ID"}]},{"description":"NAIL TIB SS 15X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407739","type":"LOCAL"},{"code":"205422","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407739 = Hospital System Supply Identifier | 205422 = Lawson ID"}]},{"description":"NAIL TIB SS 6X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407829","type":"LOCAL"},{"code":"205527","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407829 = Hospital System Supply Identifier | 205527 = Lawson ID"}]},{"description":"NAIL TIB SS 12X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407442","type":"LOCAL"},{"code":"146569","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407442 = Hospital System Supply Identifier | 146569 = Lawson ID"}]},{"description":"NAIL TIB SS 10X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"100907","type":"LOCAL"},{"code":"146559","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 100907 = Hospital System Supply Identifier | 146559 = Lawson ID"}]},{"description":"NAIL TIB SS 9X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407428","type":"LOCAL"},{"code":"146553","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407428 = Hospital System Supply Identifier | 146553 = Lawson ID"}]},{"description":"NAIL TIB SS 8X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407423","type":"LOCAL"},{"code":"146548","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407423 = Hospital System Supply Identifier | 146548 = Lawson ID"}]},{"description":"NAIL TIB SS 11X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407437","type":"LOCAL"},{"code":"146564","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407437 = Hospital System Supply Identifier | 146564 = Lawson ID"}]},{"description":"NAIL TIB SS 9X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407669","type":"LOCAL"},{"code":"205352","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407669 = Hospital System Supply Identifier | 205352 = Lawson ID"}]},{"description":"NAIL TIB SS 10X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407679","type":"LOCAL"},{"code":"205362","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407679 = Hospital System Supply Identifier | 205362 = Lawson ID"}]},{"description":"NAIL TIB SS 11X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407694","type":"LOCAL"},{"code":"205377","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407694 = Hospital System Supply Identifier | 205377 = Lawson ID"}]},{"description":"NAIL TIB SS 12X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407709","type":"LOCAL"},{"code":"205392","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407709 = Hospital System Supply Identifier | 205392 = Lawson ID"}]},{"description":"NAIL TIB SS 13X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407717","type":"LOCAL"},{"code":"205400","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407717 = Hospital System Supply Identifier | 205400 = Lawson ID"}]},{"description":"NAIL TIB SS 14X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407729","type":"LOCAL"},{"code":"205412","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407729 = Hospital System Supply Identifier | 205412 = Lawson ID"}]},{"description":"NAIL TIB SS 15X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407740","type":"LOCAL"},{"code":"205423","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407740 = Hospital System Supply Identifier | 205423 = Lawson ID"}]},{"description":"NAIL TIB SS 7X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407823","type":"LOCAL"},{"code":"205521","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407823 = Hospital System Supply Identifier | 205521 = Lawson ID"}]},{"description":"NAIL TIB SS 8X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407834","type":"LOCAL"},{"code":"205533","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407834 = Hospital System Supply Identifier | 205533 = Lawson ID"}]},{"description":"NAIL TIB SS 8X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407835","type":"LOCAL"},{"code":"205534","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407835 = Hospital System Supply Identifier | 205534 = Lawson ID"}]},{"description":"NAIL TIB SS 15X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407741","type":"LOCAL"},{"code":"205424","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407741 = Hospital System Supply Identifier | 205424 = Lawson ID"}]},{"description":"NAIL TIB SS 13X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407718","type":"LOCAL"},{"code":"205401","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407718 = Hospital System Supply Identifier | 205401 = Lawson ID"}]},{"description":"NAIL TIB SS 14X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407730","type":"LOCAL"},{"code":"205413","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407730 = Hospital System Supply Identifier | 205413 = Lawson ID"}]},{"description":"NAIL TIB SS 11X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407697","type":"LOCAL"},{"code":"205380","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407697 = Hospital System Supply Identifier | 205380 = Lawson ID"}]},{"description":"NAIL TIB SS 10X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407680","type":"LOCAL"},{"code":"205363","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407680 = Hospital System Supply Identifier | 205363 = Lawson ID"}]},{"description":"NAIL TIB SS 9X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407670","type":"LOCAL"},{"code":"205353","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407670 = Hospital System Supply Identifier | 205353 = Lawson ID"}]},{"description":"NAIL TIB SS 12X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407710","type":"LOCAL"},{"code":"205393","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407710 = Hospital System Supply Identifier | 205393 = Lawson ID"}]},{"description":"NAIL TIB SS 10X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407681","type":"LOCAL"},{"code":"205364","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407681 = Hospital System Supply Identifier | 205364 = Lawson ID"}]},{"description":"NAIL TIB SS 11X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407698","type":"LOCAL"},{"code":"205381","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407698 = Hospital System Supply Identifier | 205381 = Lawson ID"}]},{"description":"NAIL TIB SS 12X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407711","type":"LOCAL"},{"code":"205394","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407711 = Hospital System Supply Identifier | 205394 = Lawson ID"}]},{"description":"NAIL TIB SS 13X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407719","type":"LOCAL"},{"code":"205402","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407719 = Hospital System Supply Identifier | 205402 = Lawson ID"}]},{"description":"NAIL TIB SS 14X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407731","type":"LOCAL"},{"code":"205414","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407731 = Hospital System Supply Identifier | 205414 = Lawson ID"}]},{"description":"NAIL TIB SS 15X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407742","type":"LOCAL"},{"code":"205425","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407742 = Hospital System Supply Identifier | 205425 = Lawson ID"}]},{"description":"NAIL TIB SS 13X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407720","type":"LOCAL"},{"code":"205403","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407720 = Hospital System Supply Identifier | 205403 = Lawson ID"}]},{"description":"NAIL TIB SS 11X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407700","type":"LOCAL"},{"code":"205383","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407700 = Hospital System Supply Identifier | 205383 = Lawson ID"}]},{"description":"NAIL TIB SS 12X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407712","type":"LOCAL"},{"code":"205395","type":"LOCAL"}],"standard_charges":[{"gross_charge":3338.88,"discounted_cash":1168.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407712 = Hospital System Supply Identifier | 205395 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410363","type":"LOCAL"},{"code":"411619","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410363 = Hospital System Supply Identifier | 411619 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410364","type":"LOCAL"},{"code":"411620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410364 = Hospital System Supply Identifier | 411620 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410365","type":"LOCAL"},{"code":"411621","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410365 = Hospital System Supply Identifier | 411621 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410366","type":"LOCAL"},{"code":"411622","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410366 = Hospital System Supply Identifier | 411622 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410367","type":"LOCAL"},{"code":"411623","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410367 = Hospital System Supply Identifier | 411623 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410371","type":"LOCAL"},{"code":"411627","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410371 = Hospital System Supply Identifier | 411627 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410372","type":"LOCAL"},{"code":"411628","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410372 = Hospital System Supply Identifier | 411628 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410370","type":"LOCAL"},{"code":"411626","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410370 = Hospital System Supply Identifier | 411626 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410373","type":"LOCAL"},{"code":"411629","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410373 = Hospital System Supply Identifier | 411629 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410368","type":"LOCAL"},{"code":"411624","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410368 = Hospital System Supply Identifier | 411624 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410362","type":"LOCAL"},{"code":"411293","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410362 = Hospital System Supply Identifier | 411293 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410369","type":"LOCAL"},{"code":"411625","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410369 = Hospital System Supply Identifier | 411625 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410374","type":"LOCAL"},{"code":"411630","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410374 = Hospital System Supply Identifier | 411630 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410377","type":"LOCAL"},{"code":"411633","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410377 = Hospital System Supply Identifier | 411633 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410378","type":"LOCAL"},{"code":"411634","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410378 = Hospital System Supply Identifier | 411634 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410375","type":"LOCAL"},{"code":"411631","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410375 = Hospital System Supply Identifier | 411631 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410376","type":"LOCAL"},{"code":"411632","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410376 = Hospital System Supply Identifier | 411632 = Lawson ID"}]},{"description":"NAIL HUM SS 9X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407801","type":"LOCAL"},{"code":"205497","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407801 = Hospital System Supply Identifier | 205497 = Lawson ID"}]},{"description":"NAIL HUM SS 10X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407806","type":"LOCAL"},{"code":"205502","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407806 = Hospital System Supply Identifier | 205502 = Lawson ID"}]},{"description":"NAIL HUM SS 8X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407796","type":"LOCAL"},{"code":"205492","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407796 = Hospital System Supply Identifier | 205492 = Lawson ID"}]},{"description":"NAIL HUM SS 7X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407792","type":"LOCAL"},{"code":"205488","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407792 = Hospital System Supply Identifier | 205488 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410381","type":"LOCAL"},{"code":"411637","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410381 = Hospital System Supply Identifier | 411637 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410380","type":"LOCAL"},{"code":"411636","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410380 = Hospital System Supply Identifier | 411636 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX255MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410379","type":"LOCAL"},{"code":"411635","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410379 = Hospital System Supply Identifier | 411635 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410382","type":"LOCAL"},{"code":"411638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410382 = Hospital System Supply Identifier | 411638 = Lawson ID"}]},{"description":"NAIL HUM SS 9X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407802","type":"LOCAL"},{"code":"205498","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407802 = Hospital System Supply Identifier | 205498 = Lawson ID"}]},{"description":"NAIL HUM SS 8X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407797","type":"LOCAL"},{"code":"205493","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407797 = Hospital System Supply Identifier | 205493 = Lawson ID"}]},{"description":"NAIL HUM SS 7X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407793","type":"LOCAL"},{"code":"205489","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407793 = Hospital System Supply Identifier | 205489 = Lawson ID"}]},{"description":"NAIL HUM SS 10X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407807","type":"LOCAL"},{"code":"205503","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407807 = Hospital System Supply Identifier | 205503 = Lawson ID"}]},{"description":"NAIL HUM SS 7X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407794","type":"LOCAL"},{"code":"205490","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407794 = Hospital System Supply Identifier | 205490 = Lawson ID"}]},{"description":"NAIL HUM SS 8X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407798","type":"LOCAL"},{"code":"205494","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407798 = Hospital System Supply Identifier | 205494 = Lawson ID"}]},{"description":"NAIL HUM SS 9X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407803","type":"LOCAL"},{"code":"205499","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407803 = Hospital System Supply Identifier | 205499 = Lawson ID"}]},{"description":"NAIL HUM SS 10X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407808","type":"LOCAL"},{"code":"205504","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407808 = Hospital System Supply Identifier | 205504 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410383","type":"LOCAL"},{"code":"411639","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410383 = Hospital System Supply Identifier | 411639 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410384","type":"LOCAL"},{"code":"411640","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410384 = Hospital System Supply Identifier | 411640 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410385","type":"LOCAL"},{"code":"411641","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410385 = Hospital System Supply Identifier | 411641 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410386","type":"LOCAL"},{"code":"411642","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410386 = Hospital System Supply Identifier | 411642 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410387","type":"LOCAL"},{"code":"411644","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410387 = Hospital System Supply Identifier | 411644 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410388","type":"LOCAL"},{"code":"411645","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410388 = Hospital System Supply Identifier | 411645 = Lawson ID"}]},{"description":"NAIL HUM SS 11X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"409546","type":"LOCAL"},{"code":"401978","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 409546 = Hospital System Supply Identifier | 401978 = Lawson ID"}]},{"description":"NAIL HUM SS 9X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407804","type":"LOCAL"},{"code":"205500","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407804 = Hospital System Supply Identifier | 205500 = Lawson ID"}]},{"description":"NAIL HUM SS 8X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407799","type":"LOCAL"},{"code":"205495","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407799 = Hospital System Supply Identifier | 205495 = Lawson ID"}]},{"description":"NAIL HUM SS 7X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407795","type":"LOCAL"},{"code":"205491","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407795 = Hospital System Supply Identifier | 205491 = Lawson ID"}]},{"description":"NAIL HUM SS 10X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407499","type":"LOCAL"},{"code":"152149","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407499 = Hospital System Supply Identifier | 152149 = Lawson ID"}]},{"description":"NAIL HUM SS 8X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407800","type":"LOCAL"},{"code":"205496","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407800 = Hospital System Supply Identifier | 205496 = Lawson ID"}]},{"description":"NAIL HUM SS 9X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407805","type":"LOCAL"},{"code":"205501","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407805 = Hospital System Supply Identifier | 205501 = Lawson ID"}]},{"description":"NAIL HUM SS 10X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407809","type":"LOCAL"},{"code":"205505","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407809 = Hospital System Supply Identifier | 205505 = Lawson ID"}]},{"description":"NAIL HUM SS 7X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408817","type":"LOCAL"},{"code":"339947","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408817 = Hospital System Supply Identifier | 339947 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410389","type":"LOCAL"},{"code":"411646","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410389 = Hospital System Supply Identifier | 411646 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410390","type":"LOCAL"},{"code":"411647","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410390 = Hospital System Supply Identifier | 411647 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410391","type":"LOCAL"},{"code":"411648","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410391 = Hospital System Supply Identifier | 411648 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410392","type":"LOCAL"},{"code":"411649","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410392 = Hospital System Supply Identifier | 411649 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410400","type":"LOCAL"},{"code":"411657","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410400 = Hospital System Supply Identifier | 411657 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410399","type":"LOCAL"},{"code":"411656","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410399 = Hospital System Supply Identifier | 411656 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410398","type":"LOCAL"},{"code":"411655","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410398 = Hospital System Supply Identifier | 411655 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410397","type":"LOCAL"},{"code":"411654","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410397 = Hospital System Supply Identifier | 411654 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410393","type":"LOCAL"},{"code":"411650","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410393 = Hospital System Supply Identifier | 411650 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410395","type":"LOCAL"},{"code":"411652","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410395 = Hospital System Supply Identifier | 411652 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410394","type":"LOCAL"},{"code":"411651","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410394 = Hospital System Supply Identifier | 411651 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410396","type":"LOCAL"},{"code":"411653","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410396 = Hospital System Supply Identifier | 411653 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410405","type":"LOCAL"},{"code":"411662","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410405 = Hospital System Supply Identifier | 411662 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410407","type":"LOCAL"},{"code":"411664","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410407 = Hospital System Supply Identifier | 411664 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410406","type":"LOCAL"},{"code":"411663","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410406 = Hospital System Supply Identifier | 411663 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410404","type":"LOCAL"},{"code":"411661","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410404 = Hospital System Supply Identifier | 411661 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410401","type":"LOCAL"},{"code":"411658","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410401 = Hospital System Supply Identifier | 411658 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410402","type":"LOCAL"},{"code":"411659","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410402 = Hospital System Supply Identifier | 411659 = Lawson ID"}]},{"description":"NAIL HUM SS 11X300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407500","type":"LOCAL"},{"code":"155950","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407500 = Hospital System Supply Identifier | 155950 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410403","type":"LOCAL"},{"code":"411660","type":"LOCAL"}],"standard_charges":[{"gross_charge":4446.0,"discounted_cash":1556.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410403 = Hospital System Supply Identifier | 411660 = Lawson ID"}]},{"description":"DISC - TROCAR DISTAL 3.7","code_information":[{"code":"Sx00-2255-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"407490","type":"LOCAL"},{"code":"147987","type":"LOCAL"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":150.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407490 = Hospital System Supply Identifier | 147987 = Lawson ID"}]},{"description":"GUIDE PIN 2.4 SMOOTH","code_information":[{"code":"Sx00-2255-025","type":"CDM"},{"code":"272","type":"RC"},{"code":"81919","type":"LOCAL"},{"code":"155954","type":"LOCAL"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 81919 = Hospital System Supply Identifier | 155954 = Lawson ID"}]},{"description":"DISC - BIT DRILL TIB-HUM M/DN 3.7MM","code_information":[{"code":"Sx00-2255-032","type":"CDM"},{"code":"272","type":"RC"},{"code":"407488","type":"LOCAL"},{"code":"147985","type":"LOCAL"}],"standard_charges":[{"gross_charge":670.8,"discounted_cash":234.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407488 = Hospital System Supply Identifier | 147985 = Lawson ID"}]},{"description":"DISC - BIT DRILL PILOT TIP DST 3.2MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"407492","type":"LOCAL"},{"code":"147989","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.4,"discounted_cash":171.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407492 = Hospital System Supply Identifier | 147989 = Lawson ID"}]},{"description":"BIT DRILL PILOT TIP DST 3.7MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"407493","type":"LOCAL"},{"code":"147990","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.4,"discounted_cash":171.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407493 = Hospital System Supply Identifier | 147990 = Lawson ID"}]},{"description":"DISC - BIT DRILL PILOT TIP DST 5.0MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"407494","type":"LOCAL"},{"code":"147991","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.4,"discounted_cash":171.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407494 = Hospital System Supply Identifier | 147991 = Lawson ID"}]},{"description":"BOLT TIBIAL PROX LOCKING","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408250","type":"LOCAL"},{"code":"303896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1815.45,"discounted_cash":635.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408250 = Hospital System Supply Identifier | 303896 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408822","type":"LOCAL"},{"code":"339953","type":"LOCAL"}],"standard_charges":[{"gross_charge":3115.64,"discounted_cash":1090.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408822 = Hospital System Supply Identifier | 339953 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408821","type":"LOCAL"},{"code":"339952","type":"LOCAL"}],"standard_charges":[{"gross_charge":3115.64,"discounted_cash":1090.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408821 = Hospital System Supply Identifier | 339952 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408820","type":"LOCAL"},{"code":"339951","type":"LOCAL"}],"standard_charges":[{"gross_charge":3115.64,"discounted_cash":1090.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408820 = Hospital System Supply Identifier | 339951 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408708","type":"LOCAL"},{"code":"339248","type":"LOCAL"}],"standard_charges":[{"gross_charge":3115.64,"discounted_cash":1090.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408708 = Hospital System Supply Identifier | 339248 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408819","type":"LOCAL"},{"code":"339950","type":"LOCAL"}],"standard_charges":[{"gross_charge":3115.64,"discounted_cash":1090.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408819 = Hospital System Supply Identifier | 339950 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 15X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"149446","type":"LOCAL"},{"code":"236820","type":"LOCAL"}],"standard_charges":[{"gross_charge":3115.64,"discounted_cash":1090.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 149446 = Hospital System Supply Identifier | 236820 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408832","type":"LOCAL"},{"code":"339963","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408832 = Hospital System Supply Identifier | 339963 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408828","type":"LOCAL"},{"code":"339959","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408828 = Hospital System Supply Identifier | 339959 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408831","type":"LOCAL"},{"code":"339962","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408831 = Hospital System Supply Identifier | 339962 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408830","type":"LOCAL"},{"code":"339961","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408830 = Hospital System Supply Identifier | 339961 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408829","type":"LOCAL"},{"code":"339960","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408829 = Hospital System Supply Identifier | 339960 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408827","type":"LOCAL"},{"code":"339958","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408827 = Hospital System Supply Identifier | 339958 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408825","type":"LOCAL"},{"code":"339956","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408825 = Hospital System Supply Identifier | 339956 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408824","type":"LOCAL"},{"code":"339955","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408824 = Hospital System Supply Identifier | 339955 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408823","type":"LOCAL"},{"code":"339954","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408823 = Hospital System Supply Identifier | 339954 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408826","type":"LOCAL"},{"code":"339957","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408826 = Hospital System Supply Identifier | 339957 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408450","type":"LOCAL"},{"code":"332581","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408450 = Hospital System Supply Identifier | 332581 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408449","type":"LOCAL"},{"code":"332580","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408449 = Hospital System Supply Identifier | 332580 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408448","type":"LOCAL"},{"code":"332579","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408448 = Hospital System Supply Identifier | 332579 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408447","type":"LOCAL"},{"code":"332578","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408447 = Hospital System Supply Identifier | 332578 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408446","type":"LOCAL"},{"code":"332577","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408446 = Hospital System Supply Identifier | 332577 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408444","type":"LOCAL"},{"code":"332575","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408444 = Hospital System Supply Identifier | 332575 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408443","type":"LOCAL"},{"code":"332574","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408443 = Hospital System Supply Identifier | 332574 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408442","type":"LOCAL"},{"code":"332573","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408442 = Hospital System Supply Identifier | 332573 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408441","type":"LOCAL"},{"code":"332572","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408441 = Hospital System Supply Identifier | 332572 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408445","type":"LOCAL"},{"code":"332576","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408445 = Hospital System Supply Identifier | 332576 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408457","type":"LOCAL"},{"code":"332588","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408457 = Hospital System Supply Identifier | 332588 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408460","type":"LOCAL"},{"code":"332591","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408460 = Hospital System Supply Identifier | 332591 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408459","type":"LOCAL"},{"code":"332590","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408459 = Hospital System Supply Identifier | 332590 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408458","type":"LOCAL"},{"code":"332589","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408458 = Hospital System Supply Identifier | 332589 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408456","type":"LOCAL"},{"code":"332587","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408456 = Hospital System Supply Identifier | 332587 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408451","type":"LOCAL"},{"code":"332582","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408451 = Hospital System Supply Identifier | 332582 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408454","type":"LOCAL"},{"code":"332585","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408454 = Hospital System Supply Identifier | 332585 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408452","type":"LOCAL"},{"code":"332583","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408452 = Hospital System Supply Identifier | 332583 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408455","type":"LOCAL"},{"code":"332586","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408455 = Hospital System Supply Identifier | 332586 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408453","type":"LOCAL"},{"code":"332584","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408453 = Hospital System Supply Identifier | 332584 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408461","type":"LOCAL"},{"code":"332592","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408461 = Hospital System Supply Identifier | 332592 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408462","type":"LOCAL"},{"code":"332593","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408462 = Hospital System Supply Identifier | 332593 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408463","type":"LOCAL"},{"code":"332594","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408463 = Hospital System Supply Identifier | 332594 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408464","type":"LOCAL"},{"code":"332595","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408464 = Hospital System Supply Identifier | 332595 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408465","type":"LOCAL"},{"code":"332596","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408465 = Hospital System Supply Identifier | 332596 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408466","type":"LOCAL"},{"code":"332597","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408466 = Hospital System Supply Identifier | 332597 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408833","type":"LOCAL"},{"code":"339964","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408833 = Hospital System Supply Identifier | 339964 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408834","type":"LOCAL"},{"code":"339965","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408834 = Hospital System Supply Identifier | 339965 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408835","type":"LOCAL"},{"code":"339966","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408835 = Hospital System Supply Identifier | 339966 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408836","type":"LOCAL"},{"code":"339967","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408836 = Hospital System Supply Identifier | 339967 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408473","type":"LOCAL"},{"code":"332604","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408473 = Hospital System Supply Identifier | 332604 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408837","type":"LOCAL"},{"code":"339968","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408837 = Hospital System Supply Identifier | 339968 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408475","type":"LOCAL"},{"code":"332606","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408475 = Hospital System Supply Identifier | 332606 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408474","type":"LOCAL"},{"code":"332605","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408474 = Hospital System Supply Identifier | 332605 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408472","type":"LOCAL"},{"code":"332603","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408472 = Hospital System Supply Identifier | 332603 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408471","type":"LOCAL"},{"code":"332602","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408471 = Hospital System Supply Identifier | 332602 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408470","type":"LOCAL"},{"code":"332601","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408470 = Hospital System Supply Identifier | 332601 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408469","type":"LOCAL"},{"code":"332600","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408469 = Hospital System Supply Identifier | 332600 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408468","type":"LOCAL"},{"code":"332599","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408468 = Hospital System Supply Identifier | 332599 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408467","type":"LOCAL"},{"code":"332598","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408467 = Hospital System Supply Identifier | 332598 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408838","type":"LOCAL"},{"code":"339969","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408838 = Hospital System Supply Identifier | 339969 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408484","type":"LOCAL"},{"code":"332615","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408484 = Hospital System Supply Identifier | 332615 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408483","type":"LOCAL"},{"code":"332614","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408483 = Hospital System Supply Identifier | 332614 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408482","type":"LOCAL"},{"code":"332613","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408482 = Hospital System Supply Identifier | 332613 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408481","type":"LOCAL"},{"code":"332612","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408481 = Hospital System Supply Identifier | 332612 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408480","type":"LOCAL"},{"code":"332611","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408480 = Hospital System Supply Identifier | 332611 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408479","type":"LOCAL"},{"code":"332610","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408479 = Hospital System Supply Identifier | 332610 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408478","type":"LOCAL"},{"code":"332609","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408478 = Hospital System Supply Identifier | 332609 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408477","type":"LOCAL"},{"code":"332608","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408477 = Hospital System Supply Identifier | 332608 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408476","type":"LOCAL"},{"code":"332607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408476 = Hospital System Supply Identifier | 332607 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408493","type":"LOCAL"},{"code":"332624","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408493 = Hospital System Supply Identifier | 332624 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408492","type":"LOCAL"},{"code":"332623","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408492 = Hospital System Supply Identifier | 332623 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408491","type":"LOCAL"},{"code":"332622","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408491 = Hospital System Supply Identifier | 332622 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408839","type":"LOCAL"},{"code":"339970","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408839 = Hospital System Supply Identifier | 339970 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408490","type":"LOCAL"},{"code":"332621","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408490 = Hospital System Supply Identifier | 332621 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408488","type":"LOCAL"},{"code":"332619","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408488 = Hospital System Supply Identifier | 332619 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408485","type":"LOCAL"},{"code":"332616","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408485 = Hospital System Supply Identifier | 332616 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408489","type":"LOCAL"},{"code":"332620","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408489 = Hospital System Supply Identifier | 332620 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408487","type":"LOCAL"},{"code":"332618","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408487 = Hospital System Supply Identifier | 332618 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408486","type":"LOCAL"},{"code":"332617","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408486 = Hospital System Supply Identifier | 332617 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408840","type":"LOCAL"},{"code":"339971","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408840 = Hospital System Supply Identifier | 339971 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408502","type":"LOCAL"},{"code":"332633","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408502 = Hospital System Supply Identifier | 332633 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408501","type":"LOCAL"},{"code":"332632","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408501 = Hospital System Supply Identifier | 332632 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408499","type":"LOCAL"},{"code":"332630","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408499 = Hospital System Supply Identifier | 332630 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408500","type":"LOCAL"},{"code":"332631","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408500 = Hospital System Supply Identifier | 332631 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408497","type":"LOCAL"},{"code":"332628","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408497 = Hospital System Supply Identifier | 332628 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408496","type":"LOCAL"},{"code":"332627","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408496 = Hospital System Supply Identifier | 332627 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408495","type":"LOCAL"},{"code":"332626","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408495 = Hospital System Supply Identifier | 332626 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408494","type":"LOCAL"},{"code":"332625","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408494 = Hospital System Supply Identifier | 332625 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408498","type":"LOCAL"},{"code":"332629","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408498 = Hospital System Supply Identifier | 332629 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408512","type":"LOCAL"},{"code":"332643","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408512 = Hospital System Supply Identifier | 332643 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408511","type":"LOCAL"},{"code":"332642","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408511 = Hospital System Supply Identifier | 332642 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408510","type":"LOCAL"},{"code":"332641","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408510 = Hospital System Supply Identifier | 332641 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408509","type":"LOCAL"},{"code":"332640","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408509 = Hospital System Supply Identifier | 332640 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408508","type":"LOCAL"},{"code":"332639","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408508 = Hospital System Supply Identifier | 332639 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408507","type":"LOCAL"},{"code":"332638","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408507 = Hospital System Supply Identifier | 332638 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408505","type":"LOCAL"},{"code":"332636","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408505 = Hospital System Supply Identifier | 332636 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408504","type":"LOCAL"},{"code":"332635","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408504 = Hospital System Supply Identifier | 332635 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408503","type":"LOCAL"},{"code":"332634","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408503 = Hospital System Supply Identifier | 332634 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408506","type":"LOCAL"},{"code":"332637","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408506 = Hospital System Supply Identifier | 332637 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408522","type":"LOCAL"},{"code":"332653","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408522 = Hospital System Supply Identifier | 332653 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408521","type":"LOCAL"},{"code":"332652","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408521 = Hospital System Supply Identifier | 332652 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408520","type":"LOCAL"},{"code":"332651","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408520 = Hospital System Supply Identifier | 332651 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408519","type":"LOCAL"},{"code":"332650","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408519 = Hospital System Supply Identifier | 332650 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408518","type":"LOCAL"},{"code":"332649","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408518 = Hospital System Supply Identifier | 332649 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408516","type":"LOCAL"},{"code":"332647","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408516 = Hospital System Supply Identifier | 332647 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408515","type":"LOCAL"},{"code":"332646","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408515 = Hospital System Supply Identifier | 332646 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408514","type":"LOCAL"},{"code":"332645","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408514 = Hospital System Supply Identifier | 332645 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408513","type":"LOCAL"},{"code":"332644","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408513 = Hospital System Supply Identifier | 332644 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408517","type":"LOCAL"},{"code":"332648","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408517 = Hospital System Supply Identifier | 332648 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408529","type":"LOCAL"},{"code":"332660","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408529 = Hospital System Supply Identifier | 332660 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408532","type":"LOCAL"},{"code":"332663","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408532 = Hospital System Supply Identifier | 332663 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408531","type":"LOCAL"},{"code":"332662","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408531 = Hospital System Supply Identifier | 332662 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408530","type":"LOCAL"},{"code":"332661","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408530 = Hospital System Supply Identifier | 332661 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408528","type":"LOCAL"},{"code":"332659","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408528 = Hospital System Supply Identifier | 332659 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408527","type":"LOCAL"},{"code":"332658","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408527 = Hospital System Supply Identifier | 332658 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408526","type":"LOCAL"},{"code":"332657","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408526 = Hospital System Supply Identifier | 332657 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408525","type":"LOCAL"},{"code":"332656","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408525 = Hospital System Supply Identifier | 332656 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408524","type":"LOCAL"},{"code":"332655","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408524 = Hospital System Supply Identifier | 332655 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408523","type":"LOCAL"},{"code":"332654","type":"LOCAL"}],"standard_charges":[{"gross_charge":4593.39,"discounted_cash":1607.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408523 = Hospital System Supply Identifier | 332654 = Lawson ID"}]},{"description":"DISC - BIT DRILL FEM ITST 5.0MM","code_information":[{"code":"Sx00-2258-069","type":"CDM"},{"code":"272","type":"RC"},{"code":"149449","type":"LOCAL"},{"code":"236823","type":"LOCAL"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 149449 = Hospital System Supply Identifier | 236823 = Lawson ID"}]},{"description":"DISC - BIT DRILL FEM ITST 3.7MM","code_information":[{"code":"Sx00-2258-069","type":"CDM"},{"code":"272","type":"RC"},{"code":"149450","type":"LOCAL"},{"code":"236824","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 149450 = Hospital System Supply Identifier | 236824 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X120MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408843","type":"LOCAL"},{"code":"339974","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408843 = Hospital System Supply Identifier | 339974 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X115MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408842","type":"LOCAL"},{"code":"339973","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408842 = Hospital System Supply Identifier | 339973 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X110MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408841","type":"LOCAL"},{"code":"339972","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408841 = Hospital System Supply Identifier | 339972 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X105MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408551","type":"LOCAL"},{"code":"332682","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408551 = Hospital System Supply Identifier | 332682 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X95MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408550","type":"LOCAL"},{"code":"332681","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408550 = Hospital System Supply Identifier | 332681 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X75MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408547","type":"LOCAL"},{"code":"332678","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408547 = Hospital System Supply Identifier | 332678 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X80MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408548","type":"LOCAL"},{"code":"332679","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408548 = Hospital System Supply Identifier | 332679 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X70MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408546","type":"LOCAL"},{"code":"332677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408546 = Hospital System Supply Identifier | 332677 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X90MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408436","type":"LOCAL"},{"code":"332557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408436 = Hospital System Supply Identifier | 332557 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X100MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"149447","type":"LOCAL"},{"code":"236821","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 149447 = Hospital System Supply Identifier | 236821 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X85MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408549","type":"LOCAL"},{"code":"332680","type":"LOCAL"}],"standard_charges":[{"gross_charge":1602.76,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408549 = Hospital System Supply Identifier | 332680 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-20","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408537","type":"LOCAL"},{"code":"332668","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408537 = Hospital System Supply Identifier | 332668 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-10","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408535","type":"LOCAL"},{"code":"332666","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408535 = Hospital System Supply Identifier | 332666 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-15","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408536","type":"LOCAL"},{"code":"332667","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408536 = Hospital System Supply Identifier | 332667 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-00","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408533","type":"LOCAL"},{"code":"332664","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408533 = Hospital System Supply Identifier | 332664 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-05","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408534","type":"LOCAL"},{"code":"332665","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408534 = Hospital System Supply Identifier | 332665 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-00","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408538","type":"LOCAL"},{"code":"332669","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408538 = Hospital System Supply Identifier | 332669 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-10","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408539","type":"LOCAL"},{"code":"332670","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408539 = Hospital System Supply Identifier | 332670 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-15","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408540","type":"LOCAL"},{"code":"332671","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408540 = Hospital System Supply Identifier | 332671 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-05","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408844","type":"LOCAL"},{"code":"339975","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408844 = Hospital System Supply Identifier | 339975 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-20","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408845","type":"LOCAL"},{"code":"339976","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408845 = Hospital System Supply Identifier | 339976 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-15","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408544","type":"LOCAL"},{"code":"332675","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408544 = Hospital System Supply Identifier | 332675 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-20","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408545","type":"LOCAL"},{"code":"332676","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408545 = Hospital System Supply Identifier | 332676 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-05","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408542","type":"LOCAL"},{"code":"332673","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408542 = Hospital System Supply Identifier | 332673 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-00","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408541","type":"LOCAL"},{"code":"332672","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408541 = Hospital System Supply Identifier | 332672 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-10","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408543","type":"LOCAL"},{"code":"332674","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":229.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408543 = Hospital System Supply Identifier | 332674 = Lawson ID"}]},{"description":"BIT SCREWDRIVER HEX HD 3.5MM","code_information":[{"code":"Sx00-2305-017","type":"CDM"},{"code":"272","type":"RC"},{"code":"167243","type":"LOCAL"},{"code":"160088","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.5,"discounted_cash":106.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 167243 = Hospital System Supply Identifier | 160088 = Lawson ID"}]},{"description":"NUT ECT 11 X 8 MM 2317-01","code_information":[{"code":"Sx00-2317-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39355","type":"LOCAL"},{"code":"157809","type":"LOCAL"}],"standard_charges":[{"gross_charge":65.65,"discounted_cash":22.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 39355 = Hospital System Supply Identifier | 157809 = Lawson ID"}]},{"description":"TAP SURG PERIARTC Q/C 4 130X35","code_information":[{"code":"Sx00-2346-046","type":"CDM"},{"code":"272","type":"RC"},{"code":"408076","type":"LOCAL"},{"code":"245986","type":"LOCAL"}],"standard_charges":[{"gross_charge":341.25,"discounted_cash":119.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408076 = Hospital System Supply Identifier | 245986 = Lawson ID"}]},{"description":"PLATE PERI-ART 2347-12-04","code_information":[{"code":"Sx00-2347-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"80197","type":"LOCAL"},{"code":"203545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2875.08,"discounted_cash":1006.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 80197 = Hospital System Supply Identifier | 203545 = Lawson ID"}]},{"description":"SCREW PERIRTC 16MM THRD 6.5X25","code_information":[{"code":"Sx00-2347-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"408074","type":"LOCAL"},{"code":"245983","type":"LOCAL"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":27.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 408074 = Hospital System Supply Identifier | 245983 = Lawson ID"}]},{"description":"PLATE HUM LAT DST 92MM 4H RT","code_information":[{"code":"Sx00-2348-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"410174","type":"LOCAL"},{"code":"410416","type":"LOCAL"}],"standard_charges":[{"gross_charge":2875.08,"discounted_cash":1006.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 410174 = Hospital System Supply Identifier | 410416 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 10H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407967","type":"LOCAL"},{"code":"228837","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407967 = Hospital System Supply Identifier | 228837 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 2H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407971","type":"LOCAL"},{"code":"228841","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407971 = Hospital System Supply Identifier | 228841 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 14H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407963","type":"LOCAL"},{"code":"228833","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407963 = Hospital System Supply Identifier | 228833 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 12H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407965","type":"LOCAL"},{"code":"228835","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407965 = Hospital System Supply Identifier | 228835 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-6","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407952","type":"LOCAL"},{"code":"208697","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407952 = Hospital System Supply Identifier | 208697 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-4","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"56229","type":"LOCAL"},{"code":"208696","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 56229 = Hospital System Supply Identifier | 208696 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-8","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407953","type":"LOCAL"},{"code":"208698","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407953 = Hospital System Supply Identifier | 208698 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 2H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407970","type":"LOCAL"},{"code":"228840","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407970 = Hospital System Supply Identifier | 228840 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-4","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407954","type":"LOCAL"},{"code":"208699","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407954 = Hospital System Supply Identifier | 208699 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-6","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407955","type":"LOCAL"},{"code":"208700","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407955 = Hospital System Supply Identifier | 208700 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-8","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407956","type":"LOCAL"},{"code":"208701","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407956 = Hospital System Supply Identifier | 208701 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 14H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407962","type":"LOCAL"},{"code":"228832","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407962 = Hospital System Supply Identifier | 228832 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 12H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407964","type":"LOCAL"},{"code":"228834","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407964 = Hospital System Supply Identifier | 228834 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 10H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407966","type":"LOCAL"},{"code":"228836","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407966 = Hospital System Supply Identifier | 228836 = Lawson ID"}]},{"description":"PLATE HUMERAL DIST 2348-07-16","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407898","type":"LOCAL"},{"code":"208165","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407898 = Hospital System Supply Identifier | 208165 = Lawson ID"}]},{"description":"PLATE HUMERAL 2348-07-14","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407897","type":"LOCAL"},{"code":"208164","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407897 = Hospital System Supply Identifier | 208164 = Lawson ID"}]},{"description":"PLATE HUMERAL 2348-07-12","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"56225","type":"LOCAL"},{"code":"208163","type":"LOCAL"}],"standard_charges":[{"gross_charge":3687.84,"discounted_cash":1290.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 56225 = Hospital System Supply Identifier | 208163 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 2H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407969","type":"LOCAL"},{"code":"228839","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407969 = Hospital System Supply Identifier | 228839 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-04","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"56228","type":"LOCAL"},{"code":"208690","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 56228 = Hospital System Supply Identifier | 208690 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-06","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407948","type":"LOCAL"},{"code":"208691","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407948 = Hospital System Supply Identifier | 208691 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-08","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407949","type":"LOCAL"},{"code":"208692","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407949 = Hospital System Supply Identifier | 208692 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 12H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407959","type":"LOCAL"},{"code":"228829","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407959 = Hospital System Supply Identifier | 228829 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 10H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407961","type":"LOCAL"},{"code":"228831","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407961 = Hospital System Supply Identifier | 228831 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 14H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407973","type":"LOCAL"},{"code":"228843","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407973 = Hospital System Supply Identifier | 228843 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 6H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407950","type":"LOCAL"},{"code":"208694","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407950 = Hospital System Supply Identifier | 208694 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 14H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407972","type":"LOCAL"},{"code":"228842","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407972 = Hospital System Supply Identifier | 228842 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 12H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407974","type":"LOCAL"},{"code":"228844","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407974 = Hospital System Supply Identifier | 228844 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 2H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407968","type":"LOCAL"},{"code":"228838","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407968 = Hospital System Supply Identifier | 228838 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-10-04","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"82363","type":"LOCAL"},{"code":"208693","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 82363 = Hospital System Supply Identifier | 208693 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-10-08","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407951","type":"LOCAL"},{"code":"208695","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407951 = Hospital System Supply Identifier | 208695 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 10H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407960","type":"LOCAL"},{"code":"228830","type":"LOCAL"}],"standard_charges":[{"gross_charge":3380.54,"discounted_cash":1183.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407960 = Hospital System Supply Identifier | 228830 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-02","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407899","type":"LOCAL"},{"code":"208166","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407899 = Hospital System Supply Identifier | 208166 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-03","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407900","type":"LOCAL"},{"code":"208167","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407900 = Hospital System Supply Identifier | 208167 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-04","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407901","type":"LOCAL"},{"code":"208168","type":"LOCAL"}],"standard_charges":[{"gross_charge":2401.98,"discounted_cash":840.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407901 = Hospital System Supply Identifier | 208168 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-06","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407902","type":"LOCAL"},{"code":"208169","type":"LOCAL"}],"standard_charges":[{"gross_charge":2474.22,"discounted_cash":865.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407902 = Hospital System Supply Identifier | 208169 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-08","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407903","type":"LOCAL"},{"code":"208170","type":"LOCAL"}],"standard_charges":[{"gross_charge":2570.98,"discounted_cash":899.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407903 = Hospital System Supply Identifier | 208170 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-10","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407904","type":"LOCAL"},{"code":"208171","type":"LOCAL"}],"standard_charges":[{"gross_charge":2709.21,"discounted_cash":948.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407904 = Hospital System Supply Identifier | 208171 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-12","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407905","type":"LOCAL"},{"code":"208172","type":"LOCAL"}],"standard_charges":[{"gross_charge":2875.08,"discounted_cash":1006.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407905 = Hospital System Supply Identifier | 208172 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-10","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407911","type":"LOCAL"},{"code":"208178","type":"LOCAL"}],"standard_charges":[{"gross_charge":2709.21,"discounted_cash":948.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407911 = Hospital System Supply Identifier | 208178 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-02","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407906","type":"LOCAL"},{"code":"208173","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407906 = Hospital System Supply Identifier | 208173 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-03","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407907","type":"LOCAL"},{"code":"208174","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407907 = Hospital System Supply Identifier | 208174 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-04","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407908","type":"LOCAL"},{"code":"208175","type":"LOCAL"}],"standard_charges":[{"gross_charge":2401.98,"discounted_cash":840.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407908 = Hospital System Supply Identifier | 208175 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-06","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407909","type":"LOCAL"},{"code":"208176","type":"LOCAL"}],"standard_charges":[{"gross_charge":2474.22,"discounted_cash":865.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407909 = Hospital System Supply Identifier | 208176 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-08","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407910","type":"LOCAL"},{"code":"208177","type":"LOCAL"}],"standard_charges":[{"gross_charge":2570.98,"discounted_cash":899.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407910 = Hospital System Supply Identifier | 208177 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-12","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407912","type":"LOCAL"},{"code":"208179","type":"LOCAL"}],"standard_charges":[{"gross_charge":2875.08,"discounted_cash":1006.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407912 = Hospital System Supply Identifier | 208179 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-07","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407916","type":"LOCAL"},{"code":"208183","type":"LOCAL"}],"standard_charges":[{"gross_charge":2474.22,"discounted_cash":865.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407916 = Hospital System Supply Identifier | 208183 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-05","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407915","type":"LOCAL"},{"code":"208182","type":"LOCAL"}],"standard_charges":[{"gross_charge":2401.98,"discounted_cash":840.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407915 = Hospital System Supply Identifier | 208182 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-02","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407913","type":"LOCAL"},{"code":"208180","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407913 = Hospital System Supply Identifier | 208180 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-03","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407914","type":"LOCAL"},{"code":"208181","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407914 = Hospital System Supply Identifier | 208181 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-02","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407917","type":"LOCAL"},{"code":"208184","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407917 = Hospital System Supply Identifier | 208184 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-03","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407918","type":"LOCAL"},{"code":"208185","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407918 = Hospital System Supply Identifier | 208185 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-05","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407919","type":"LOCAL"},{"code":"208186","type":"LOCAL"}],"standard_charges":[{"gross_charge":2401.98,"discounted_cash":840.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407919 = Hospital System Supply Identifier | 208186 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-07","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407920","type":"LOCAL"},{"code":"208187","type":"LOCAL"}],"standard_charges":[{"gross_charge":2474.22,"discounted_cash":865.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407920 = Hospital System Supply Identifier | 208187 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-12","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407946","type":"LOCAL"},{"code":"208213","type":"LOCAL"}],"standard_charges":[{"gross_charge":2875.08,"discounted_cash":1006.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407946 = Hospital System Supply Identifier | 208213 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-08","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407944","type":"LOCAL"},{"code":"208211","type":"LOCAL"}],"standard_charges":[{"gross_charge":2570.98,"discounted_cash":899.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407944 = Hospital System Supply Identifier | 208211 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-06","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407943","type":"LOCAL"},{"code":"208210","type":"LOCAL"}],"standard_charges":[{"gross_charge":2474.22,"discounted_cash":865.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407943 = Hospital System Supply Identifier | 208210 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-10","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407945","type":"LOCAL"},{"code":"208212","type":"LOCAL"}],"standard_charges":[{"gross_charge":2709.21,"discounted_cash":948.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407945 = Hospital System Supply Identifier | 208212 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-03","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407941","type":"LOCAL"},{"code":"208208","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407941 = Hospital System Supply Identifier | 208208 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-02","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407940","type":"LOCAL"},{"code":"208207","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407940 = Hospital System Supply Identifier | 208207 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-04","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407942","type":"LOCAL"},{"code":"208209","type":"LOCAL"}],"standard_charges":[{"gross_charge":2401.98,"discounted_cash":840.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407942 = Hospital System Supply Identifier | 208209 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-02","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407933","type":"LOCAL"},{"code":"208200","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407933 = Hospital System Supply Identifier | 208200 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-03","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407934","type":"LOCAL"},{"code":"208201","type":"LOCAL"}],"standard_charges":[{"gross_charge":2318.19,"discounted_cash":811.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407934 = Hospital System Supply Identifier | 208201 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-04","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407935","type":"LOCAL"},{"code":"208202","type":"LOCAL"}],"standard_charges":[{"gross_charge":2401.98,"discounted_cash":840.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407935 = Hospital System Supply Identifier | 208202 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-06","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407936","type":"LOCAL"},{"code":"208203","type":"LOCAL"}],"standard_charges":[{"gross_charge":2474.22,"discounted_cash":865.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407936 = Hospital System Supply Identifier | 208203 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-08","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407937","type":"LOCAL"},{"code":"208204","type":"LOCAL"}],"standard_charges":[{"gross_charge":2570.98,"discounted_cash":899.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407937 = Hospital System Supply Identifier | 208204 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-10","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407938","type":"LOCAL"},{"code":"208205","type":"LOCAL"}],"standard_charges":[{"gross_charge":2709.21,"discounted_cash":948.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407938 = Hospital System Supply Identifier | 208205 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-12","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407939","type":"LOCAL"},{"code":"208206","type":"LOCAL"}],"standard_charges":[{"gross_charge":2875.08,"discounted_cash":1006.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407939 = Hospital System Supply Identifier | 208206 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-08","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407931","type":"LOCAL"},{"code":"208198","type":"LOCAL"}],"standard_charges":[{"gross_charge":3659.95,"discounted_cash":1280.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407931 = Hospital System Supply Identifier | 208198 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-10","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407932","type":"LOCAL"},{"code":"208199","type":"LOCAL"}],"standard_charges":[{"gross_charge":3894.76,"discounted_cash":1363.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407932 = Hospital System Supply Identifier | 208199 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-06","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"407930","type":"LOCAL"},{"code":"208197","type":"LOCAL"}],"standard_charges":[{"gross_charge":3476.11,"discounted_cash":1216.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: CLT LOCATION | 407930 = Hospital System Supply Identifier | 208197 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-01","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":